自身免疫性肝炎与原发性胆汁性胆管炎重叠综合征患者的临床病理学特征分析  

Clinicopathological characteristics of patients with overlapping syndrome of autoimmune hepatitis and primary biliary cholangitis

作　　者：张梅芹 沈兰超[1] 陈国峰[2] 吕春[1] ZHANG Mei-qin;SHEN Lan-chao;CHEN Guo-feng;LV Chun(Huaian Fourth People’s Hospital,Jiangsu 223002,China)

机构地区：[1]江苏淮安市第四人民医院肝病科,江苏223002 [2]南京医科大学附属淮安第一医院肝胆外科

出　　处：《肝脏》2020年第9期965-967,共3页Chinese Hepatology

摘　　要：目的对自身免疫性肝炎(AIH)-原发性胆汁性胆管炎(PBC)重叠综合征患者的血清学指标、自身抗体及肝脏组织病理学表现进行记录,并分析这些患者的临床病理学特征。方法选取2016年6月至2019年6月我科临床确诊的自身免疫性肝病(AILD)患者78例,其中AIH患者32例(AIH组),PBC患者24例(PBC组),AIH-PBC重叠综合征患者22例(AIH-PBC组)。对于计量资料以(■±s)表示,组间比较采用t检验分析;计数资料以百分比表示,组间比较采用卡方检验。结果 AIH-PBC组[(412.4±226.4)U/L]患者ALP明显高于AIH组[(108.2±68.1)U/L],(P<0.05);AIHPBC组[(430.5±152.8)U/L]患者GGT明显高于AIH组[(118.7±65.2)U/L](P<0.05);AIH-PBC组[(5.2±1.7)g/L]患者IgM明显高于AIH组[(2.5±0.8)g/L](P<0.05);AIH-PBC组[(182.6±68.1)U/L]中患者ALT明显高于PBC组[(98.7±45.7)U/L](P<0.05);AIH-PBC组[(174.9±70.2)U/L]中患者AST明显高于PBC组[(104.6±52.4)U/L](P<0.05);AIH-PBC组[(19.5±6.6)g/L]中患者IgG明显高于PBC组[(15.2±1.9)g/L](P<0.05)。AIHPBC组中患者(72.7%)AMA表达明显高于AIH组(0%)(P<0.05);AIH-PBC组中患者(100%)AMA M2表达明显高于AIH组(0%)(P<0.05);AIH-PBC组中患者(72.7%)SMA表达明显高于PBC组(16.7%)(P<0.05);AIH-PBC组中患者(90.9%)ANA表达明显高于PBC组(12.5%)(P<0.05)。结论 AIH-PBC组患者血清学指标、自身抗体及肝组织穿刺病理学表现兼具AIH及PBC疾病的特点,而血清生化指标、自身抗体检测水平的差异可以作为鉴别AIH-PBC重叠综合征的依据。Objective The serum biochemical indexes,autoantibodies and liver histopathological manifestations of patients with autoimmune hepatitis(AIH)-primary biliary cholangitis(PBC)overlap syndrome were recorded,and the clinical pathological characteristics of these patients were analyzed.Methods From June 2016 to June 2019,78 clinically diagnosed autoimmune liver disease(AILD)patients in our department were selected,including 32 AIH patients(AIH group),24 PBC patients(PBC group)and 22 patients with AIH-PBC overlap syndrome(AIH-PBC group).The measurement data are expressed as(■±s)and the comparison between groups is analyzed by t test.Counting data are expressed as percentages,and chi-square test is used for comparison between groups.Results ALP in AIH-PBC group[(412.4±226.4)U/L]was significantly higher than that in AIH group[(108.2±68.1)U/L](P<0.05).GGT in AIHPBC group[(430.5±152.8)U/L]was significantly higher than that in AIH group[(118.7±65.2)U/L](P<0.05).IgM in AIH-PBC group[(5.2±1.7)g/L]was significantly higher than that in AIH group[(2.5±0.8)g/L](P<0.05).ALT in AIH-PBC group[(182.6±68.1)U/L]was significantly higher than that in PBC group[(98.7±45.7)U/L].AST in AIH-PBC group[(174.9±70.2)U/L]was significantly higher than that in PBC group[(104.6±52.4)U/L];IgG in AIH-PBC group[(19.5±6.6)g/L]was significantly higher than that in PBC group[(15.2±1.9)g/L].AMA expression in patients in AIH-PBC group(72.7%)was significantly higher than that in AIH group(0%)(P<0.05).The expression of AMA M2 in patients(100%)in AIH-PBC group(100%)was significantly higher than that in AIH group(0%)(P<0.05).SMA expression in AIH-PBC group(72.7%)was significantly higher than that in PBC group(16.7%)(P<0.05).ANA expression in patients(90.9%)in AIH-PBC group was significantly higher than that in PBC group(12.5%)(P<0.05).Conclusion Serum biochemical indexes,autoantibodies and liver biopsy pathological manifestations of patients in AIH-PBC group have the characteristics of AIH and PBC diseases,while the differences in serum biochemic

关 键 词：自身免疫性肝病 自身免疫性肝炎 原发性胆汁性胆管炎 AIH-PBC重叠综合征 抗核抗体 抗平滑肌抗体 

分 类 号：R575.1[医药卫生—消化系统] R575.7[医药卫生—内科学]