急性自身免疫性肝炎的临床和病理特征  

Clinical and pathological features of acute autoimmune hepatitis

作　　者：聂虹 宋洁 时牛 NIE Hong;SONG Jie;SHI Niu(Department of Gastroenterology,People's Hospital of Inner Mongolia Autonomous Region,Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院消化内科,呼和浩特010017

出　　处：《肝脏》2021年第6期664-666,共3页Chinese Hepatology

基　　金：2018年内蒙古自治区自然科学基金-面上项目(2018MS08068)。

摘　　要：目的分析急性起病自身免疫性肝炎(AIH)患者临床和病理特征。方法选取2010年5月至2020年11月经肝穿刺活检的AIH患者74例,年龄(53.4±11.3)岁,其中急性起病AIH 28例(急性组),诊断需至少符合以下一项:总胆红素(TBil)≥85.5μmol/L,ALT(AST)≥10×正常值上限;非急性起病46例(非急性组)。(x±s)或[M(P 25,P 75)]表示计量资料,t检验或Kruskal-Wallis H检验比较;(%)表示计数资料,卡方检验比较。结果急性组、非急性组AIH患者TBIL、ALT、AST、PT、INR、IgG、抗核抗体(ANA)、肝纤维化程度等差异具有统计学意义(P<0.05),而两组患者年龄、性别、WBC、PLT、抗平滑肌抗体(ASMA)、抗肝可溶性抗原抗体(抗-SLA)、抗肝肾微粒体抗体(抗-LKM)、抗中性粒细胞浆抗体(ANCA)及肝炎炎症活动度等差异不具有统计学意义(P>0.05)。急性组、非急性组AIH患者黄疸、厌食、尿黄及厌油等差异具有统计学意义(P<0.05),而两组患者疲乏、腹水、腹痛、体重下降、下肢浮肿及关节疼痛等差异不具有统计学意义(P>0.05)。结论临床实践中以急性起病的AIH病例数量并不少见,而仅凭IAIHG评分难以甄别出这部分患者。相较于非急性AIH,急性患者肝脏转氨酶、凝血指标及肝纤维化程度均存在显著差异,这些指标将有助于区分二者。在临床表现中,急性起病AIH以黄疸、厌食、尿黄及厌油等较为多见,这将有助于临床医师早期发现。Objective Analysis of clinical and pathological features of autoimmune hepatitis(AIH)patients of acute onset.Methods A total of 74 patients with AIH,aged(53.4±11.3)years,were selected between May 2010 and November 2010.Among them,28 patients with AIH of acute onset(acute group),the diagnosis should be in accordance with at least one of the following items:total bilirubin(TBil)≥85.5μmol/L,ALT(AST)≥10×normal limit,and 46 cases of non-acute onset(non-acute group).(x±s)or[M(P 25,P 75)]represented measurement data,t-test or Kruskal-Wallis H test were used;(%)represented counting data,chi-square test were used.Results There were significant differences in TBil,ALT,AST,PT,INR,IgG,antinuclear antibody(ANA)and the degree of liver fibrosis between acute group and non-acute group of AIH(P<0.05).There was no significant difference in age,sex,WBC,PLT,anti-smooth muscle antibody(ASMA),anti-liver soluble antigen antibody(anti-SLA),anti-liver and kidney microsomal antibody(anti-LKM),anti-neutrophil cytoplasmic antibody(ANCA)and hepatitis inflammatory activity between the two groups(P>0.05).There were significant differences in jaundice,anorexia,yellow urine and oil weariness between acute group and non-acute group in AIH patients(P<0.05),but there was no significant difference in fatigue,ascites,abdominal pain,weight loss,lower limb edema and joint pain between the two groups(P>0.05).Conclusion In clinical practice,the number of AIH cases of acute onset is not uncommon,and it is difficult to identify these patients only through IAIHG score.Compared with non-acute AIH,there are significant differences in liver transaminase,coagulation index and degree of liver fibrosis in acute patients,which will help to distinguish them.In the clinical manifestations,jaundice,anorexia,yellow urine and oil-weariness are more significant in AIH of acute onset,which will help clinicians to find out in the early stage.

关 键 词：自身免疫性肝炎 抗核抗体 肝纤维化 

分 类 号：R575.1[医药卫生—消化系统]