自身免疫性肝炎临床误诊分析  

Clinical Misdiagnosis of Autoimmune Hepatitis

作　　者：王媛媛[1] 朱丽[2] 丁秀婷 WANG Yuanyuan;ZHU Li;DING Xiuting(Department of Gastroenterology,Qinhuangdao Hospital,Peking University Third Hospital,Qinhuangdao,Hebei 066000,China;Department of Medical Administration,Qinhuangdao Hospital,Peking University Third Hospital,Qinhuangdao,Hebei 066000,China)

机构地区：[1]北京大学第三医院秦皇岛医院消化科,河北秦皇岛066000 [2]北京大学第三医院秦皇岛医院医务科,河北秦皇岛066000

出　　处：《临床误诊误治》2024年第2期25-28,共4页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划项目(202101A210)。

摘　　要：目的探讨自身免疫性肝炎(AIH)的诊治措施及误诊原因、防范措施。方法回顾性分析2020年1月—2022年5月收治的AIH误诊为病毒性肝炎21例的临床资料。结果21例主要症状为食欲缺乏、乏力、黄疸、发热,伴腹胀12例,恶心5例,胸闷和胸痛4例,呕吐及关节痛各3例。体形消瘦,巩膜及皮肤黏膜黄染明显。查血丙氨酸转氨酶和天冬氨酸转氨酶升高;7例γ-谷氨酰转肽酶升高,碱性磷酸酶和总胆红素升高各6例。腹部B超检查示肝大18例,肝内回声不均。初期外院诊断为病毒性肝炎,予相应治疗15 d无好转,遂转我院。查血抗平滑肌抗体(SMA)、抗核抗体(ANA)阳性,血γ-球蛋白、IgG升高,结合肝炎病毒血清学检测阴性及相关病史,遂明确诊断为AIH。误诊时间18~21 d。确诊后,18例予泼尼松单独治疗,3例予泼尼松联合硫唑嘌呤治疗。治疗1年后随访,患者病情稳定,无复发。结论AIH发病较隐匿,以年轻女性高发,临床表现多样且无特异性,易误诊为病毒性肝炎,行肝炎病毒血清学检查及ANA、SMA、抗肝肾微粒体、免疫球蛋白或肝组织病理检查可区分二者,确诊后应及时予有效治疗,以改善患者预后。Objective To explore the diagnosis and treatment measures,causes of misdiagnosis,and preventive measures for autoimmune hepatitis(AIH).Methods The clinical data of 21 patients with AIH misdiagnosed as viral hepatitis admitted to our hospital from January 2020 to May 2022 were retrospectively analyzed.Results All the 21 patients had main symptoms,such as anorexia,fatigue,jaundice and fever,accompanied by abdominal distension(n=12),nausea(n=5),chest tightness and chest pain(n=4),vomiting(n=3),arthralgia(n=3),wasting,and obvious yellowing of sclera and skin mucosa.Serum alanine aminotransferase and aspartate aminotransferase were detected to be increased.γ-glutamyl transpeptidase was increased in 7 patients,and alkaline phosphatase and total bilirubin were increased in 6 patients.Abdominal B ultrasonography showed enlarged liver in 18 cases with uneven liver echo.Initial diagnosis of viral hepatitis in other hospitals,and patients did not respond to 15-day symptomatic treatment,and then transferred to our hospital.The blood anti-smooth muscle antibody(SMA)and anti-nuclear antibody(ANA)were positive,and the bloodγ-globulin and IgG were elevated.Based on the combined hepatitis virus serology testing that was negative,and related history,AIH was confirmed.Misdiagnosis lasted 18 to 21 days.After diagnosis,18 patients were treated with Prednisone alone,and 3 patients were treated with Prednisone combined with Azathioprine.After 1-year follow-up,patients had stable condition without recurrence.Conclusion The onset of AIH is relatively hidden,with a high incidence in young women,and the clinical manifestations are varied and non-specific,which is,therefore,more likely to be misdiagnosed as viral hepatitis.It can be distinguished by serology testing examination of hepatitis virus and ANA,SMA,anti-liver/kidney microsome,AMA,immunoglobulin or pathological examination of the liver tissue.After diagnosis,timely and effective treatment should be given to improve the prognosis of patients.

关 键 词：肝炎 自身免疫性 误诊 肝炎 病毒性 抗平滑肌抗体 抗核抗体 γ-球蛋白 IGG 肝炎病毒检测 

分 类 号：R575.1[医药卫生—消化系统]