抗线粒体抗体阳性的自身免疫性肝炎患者的临床特点及预后  

Clinical features and prognosis of autoimmune hepatitis with antimitochondrial antibody positive

作　　者：段维佳[1] 吕婷婷 陈莎 王倩怡[1] 王晓明[1] 王宇[1] 欧晓娟[1] 李淑香 DUAN Wei-jia;LYU Ting-ting;CHEN Sha(Liver Research Center,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive System Diseases,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院肝病中心,国家消化系统疾病临床医学研究中心,北京100050

出　　处：《临床和实验医学杂志》2022年第18期1931-1934,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金(编号:82000533);北京市医院管理局消化内科学科协同发展中心专项经费(编号:XXZ0501)。

摘　　要：目的探讨抗线粒体抗体(AMA)阳性自身免疫性肝炎(AIH)患者的临床特点及预后。方法回顾性选取2010年1月至2018年1月首都医科大学附属北京友谊医院收治的AIH患者61例作为研究对象,根据AMA滴度情况分为AMA阳性组(AMA滴度≥1∶80,n=9)和AMA阴性组(AMA滴度<1∶80,n=52)两组。比较AMA阳性组和AMA阴性组患者的临床特点;并进行门诊及电话随访,分析AMA阳性AIH患者治疗及预后。结果AMA阳性组患者与AMA阴性组患者在年龄[(57.6±9.9)岁vs.(57.2±10.5)岁],性别(女性比率88.9%vs.82.6%)、抗核抗体阳性率(100%vs.100%)、免疫球蛋白G[26(20.6~27.5)g/L vs.25.8(21.5~28.6)g/L]、免疫球蛋白M[15.2(12.7~24.1)g/L vs.12.5(0.8~17.9)g/L]和血清球蛋白[(40.4±7.0)g/L vs.(42.7±8.9)g/L]等方面比较,差异均无统计学意义(P>0.05)。AMA阳性组AIH患者较AMA阴性组患者的丙氨酸氨基转移酶[190(133~254)U/L vs.239(170~522)U/L,P=0.164]、天门冬氨酸氨基转移酶[160(96~296)U/L vs.289(165~541)U/L,P=0.028]以及总胆红素水平[23.7(20.9~41.3)μmol/L vs.43.0(21.3~113.5)μmol/L,P=0.190]更低,但仅天门冬氨酸氨基转移酶比较差异有统计学意义(P<0.05)。AMA阳性组所有AIH患者在使用免疫抑制剂治疗后均获得完全应答,在随访过程中均未出现PBC的特征表现。结论AMA阳性AIH患者与AMA阴性AIH患者相比在性别、年龄、免疫学、生化学特点上无明显差异。AMA阳性AIH患者在随访过程中未进展至PBC。Objective To explore the clinical characteristics and prognosis of AMA-positive autoimmune hepatitis(AIH).Methods Sixty-one AIH patients admitted to Beijing Friendship Hospital,Capital Medical University from January 2010 to January 2018 were investigated in this retrospective study.According to AMA titers,they were divided into AMA positive group(AMA titer≥1:80,n=9)and AMA negative group(AMA titer<1:80,n=52)two groups.The clinical characteristics of the AMA-positive group and the AMA-negative group were compared;outpatient and telephone follow-up were conducted to analyze the treatment and prognosis of AMA-positive AIH patients.Results There were no differences between AIH with and without AMA in age[(57.6±9.9)years vs.(57.2±10.5)years],sex(female ratio 88.9%vs.82.6%),and immunological features including antinuclear antibodies(100%vs.100%),immunoglobulin G[26(20.6-27.5)g/L vs.25.8(21.5-28.6)g/L],immunoglobulin M[15.2(12.7~24.1)g/L vs.12.5(0.8~17.9)g/L],serum globulin[(40.4±7.0)g/L vs.(42.7±8.9)g/L],and the differences were no statistically significant(P>0.05).Compared with the AMA negative group,the AIH patients in the AMA positive group had higher levels of alanine aminotransferase[190(133~254)U/L vs.239(170~522)U/L,P=0.164],aspartic transaminase[160(96~296)U/L vs.289(165~541)U/L,P=0.028]and total bilirubin level[23.7(20.9~41.3)μmol/L vs.43.0(21.3~113.5)μmol/L,P=0.190]was lower,only aspartic transaminase had statistically difference(P<0.05).All AMA-positive AIH patients had complete biochemical response to immunosuppression therapy.None of the AMA-positive AIH patients showed signs of evolving PBC features during follow-up.Conclusion AMA-positive AIH patients had similar age,sex,and immunological features to AMA negative AIH patients,but had better biochemical index.None of AMA positive AIH patients evolved towards PBC during follow-up.

关 键 词：肝炎 自身免疫性 抗线粒体抗体 原发性胆汁性胆管炎 

分 类 号：R575.1[医药卫生—消化系统]