青海地区自身免疫性肝病重叠综合征患者的抗线粒体抗体差异分析  

Characteristics of patients with primary biliary cholangitis-autoimmune hepatitis overlap syndrome and diverse anti-mitochondrial antibody in Qinghai region

作　　者：王春秋[1] 陈婷 张臻英 张晓菲 WANG Chun-qiu;CHEN Ting;ZHANG Zhen-ying;ZHANG Xiao-fei(Department of Gastroenterology,Qinghai Provincial People′s hospital,Xining 810007,China;Department of Gastroenterology,Chengdu BOE Hospital,Sichuan 620000,China;Department of Cardiology,Qinghai provincial people′s hospital,Xining 810007,China)

机构地区：[1]青海省人民医院消化内科,西宁810000 [2]青海省人民医院心内科,西宁810000 [3]成都京东方医院消化内科,610000

出　　处：《肝脏》2024年第4期448-452,共5页Chinese Hepatology

摘　　要：目的总结青海省自身免疫性肝病重叠患者的临床及病理特征,提高临床诊治水平。方法回顾性分析2017年12月—2022年12月青海省人民医院首次确诊为自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征的患者共85例,抗线粒体抗体阳性为A组共58例,抗线粒体抗体阴性为B组27例。分析一般临床特征、合并疾病情况、血清生化学指标、免疫学指标、肝组织的病理情况;计量资料符合正态分布的采用x±s表示,组间比较采用独立样本t检验;不符合正态分布的计量资料采用M(P_(25),P_(75))表示,组间比较采用Wilcoxon秩和检验;计数资料采用构成比(%)表示,组间比较采用χ^(2)检验。结果A、B两组患者在性别、年龄、总胆红素、γ-谷氨酰基转移酶、碱性磷酸酶、免疫球蛋白G的水平及抗Ro52抗体、抗SSA抗体检出率、干燥综合征患病率、肝脏病理炎症分级、肝脏病理纤维化分级的比较上无统计学差异(P>0.05);在丙氨酸氨基转移酶[(115.41±76.63)比(255.90±244.90)U/L]、免疫球蛋白M[4.05(2.75,5.43)比1.99(1.41,3.51)g/L]水平、抗核抗体-G(χ^(2)=9.67)、自身免疫性甲状腺疾病(χ^(2)=5.74)患病率的组间比较差异有统计学意义(P<0.05)。结论A组患者丙氨酸氨基转移酶、免疫球蛋白M及抗核抗体-G水平更高,B组患自身免疫性甲状腺疾病比例更高;两组病理组织学的炎症分级及纤维化分级以中重度为主,提示患者发病隐匿,病程漫长,确诊时病情分期较晚;如确诊为自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征患者,建议完善甲状腺疾病的检查。Objective To delineate the clinical and pathological characteristics of primary biliary cholangitis-autoimmune hepatitis overlap syndrome(PBC-AIH OS)in Qinghai province,aiming to enhance clinical diagnosis and treatment protocols.Methods In a retrospective study spanning December 2017 to December 2022,85 patients diagnosed with PBC-AIH OS were analyzed.The cohort was divided into two groups based on Anti-mitochondrial antibody status:58 in Group A(positive)and 27 in Group B(negative).The study evaluated general clinical features,comorbid conditions,serum biochemical markers,immunological indices,and liver tissue pathology.Date adhering to a normal distribution were presented as c±s and analyzed using the independent sample t-test.Non-normally distributed measurements were expressed as medians(P_(25),P_(75))and compared using the Wilcoxon rank-sum test.Categorical data were analyzed using chi-square tests to compare proportions between groups;with a P-value of<0.05 denoting statistical significant.Results In the comparison between the two groups,there were no statistically significant differences observed interms of sex,age,TBil,γ-GGT,ALP,IgG,Ro52 presence,the detection rate of SSA,the prevalence of Sjogren′s syndrome,and the grades of liver inflammation and fibrosis(P>0.05).However,significant differences were noted in the levels of ALT(115.41±76.63 vs.255.90±244.90)and IgM[4.05(2.75,5.43)vs.1.99(1.41,3.51)],as well as in the detection rate of ANA-G(χ^(2)=9.67)and the morbidity rate of autoimmune thyroid disease(AITD)(χ^(2)=5.74),with P<0.05 indicating statistical significance.Conclusion Patients in Group A exhibited levels of ALT,IgM and ANA-Gr detection rates,whereas the prevalence of AITD was greater in the Group B.The pathological histology for both groups predominantly revealed moderate to severe,inflammation and fibrosis rades,suggesting an insidious onset,prolonged disease course,and advanced stage at diagnosis for these patients.Given these findings,it is advisable for patients diagnosed with PBC-

关 键 词：青海地区 抗线粒体抗体 自身免疫性肝病 

分 类 号：R575[医药卫生—消化系统]