以反复发热起病伴HBsAg阳性的自身免疫性肝炎1例并文献复习  

Autoimmune hepatitis presenting with recurrent fever and HBsAg positivity:A case report and review of the literature

作　　者：赵浚彤 牛庆慧[1] 李金金 宗守凯[3] 刘欢[4] 张龙霄 Jun-Tong Zhao;Qing-Hui Niu;Jin-Jin Li;Shou-Kai Zong;Huan Liu;Long-Xiao Zhang(Department of Hepatology,The Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China;Department of Hepatology,The Sixth People’s Hospital of Qingdao,Qingdao 266000,Shandong Province,China;Department of Breast and Thyroid Surgery,Rizhao People’s Hospital,Rizhao 276800,Shandong Province,China;Department of Liver Disease,The Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China;Department of Pathology,The Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China)

机构地区：[1]青岛大学附属医院肝病内科,山东省青岛市266000 [2]青岛市第六人民医院肝病内科,山东省青岛市266000 [3]日照市人民医院乳腺甲状腺外科,山东省日照市276800 [4]青岛大学附属医院肝脏病中心,山东省青岛市266000 [5]青岛大学附属医院病理科,山东省青岛市266000

出　　处：《世界华人消化杂志》2025年第1期75-80,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金,No.82300665;青岛市2023年度医药卫生科研指导项目面上项目,No.2023-WJZD064.

摘　　要：背景自身免疫性肝炎(autoimmune hepatitis,AIH)临床表现缺乏特异性,以发热为主少见.本文报道1例以反复发热起病伴HBsAg阳性,经肝穿刺活检最终诊断的AIH患者,以提高临床医生对病理活检诊断AIH的重视.病例简介本例患者因“反复发热2年”入院,多次就诊历时两年未明病因.此次就诊我院进一步检测自身抗体并完善肝穿刺活检,最终确诊为AIH.经激素联合免疫抑制剂,并预防性抗乙肝病毒治疗后,患者病情稳定,未再复发.结论AIH常难以诊断,若有其他因素干扰则增加了诊断难度且易漏诊.感染乙型病毒性肝炎患者体内可出现自身抗体阳性,抗体效价也存在个体化差异,诊断更为困难,故应引起临床医师关注.对于是否合并AIH,应及时给予肝组织学检查明确诊断.尽早开始免疫抑制治疗对延缓疾病进展,改善患者预后有着重要意义.BACKGROUND The clinical manifestations of autoimmune hepatitis(AIH)lack specificity,with fever being uncommon.This paper presents a case of AIH characterized by recurrent fever and HBsAg positivity,ultimately diagnosed through liver biopsy,highlighting the importance of pathological evaluation in accurately diagnosing AIH.CASE SUMMARY A patient was admitted to the hospital due to“recurrent fever lasting for two years”,with an unknown etiology despite multiple visits over this period.In our hospital,a final diagnosis of AIH was achieved through further testing of autoantibodies and a liver biopsy.Following treatment with corticosteroids combined with immunosuppressants and prophylactic therapy against hepatitis B virus,the patient’s condition stabilized,and no recurrence has been observed.CONCLUSION AIH is often challenging to diagnose,and the presence of confounding factors can further complicate the diagnostic process,leading to a higher likelihood of missed diagnoses.Positive autoantibodies may be detected in patients with hepatitis B,and there are notable individual variations in antibody titers.Consequently,this variability adds complexity to the diagnosis,which clinicians should be particularly mindful of.For both patients with and without AIH,timely liver histology assessment is essential for confirming the diagnosis.The early initiation of immunosuppressive therapy holds significant importance in delaying disease progression and improving patient prognosis.

关 键 词：自身免疫性肝炎 乙型病毒性肝炎 乙型肝炎表面抗原 抗核抗体 免疫球蛋白G 发热 慢性乙型肝炎 

分 类 号：R57[医药卫生—消化系统]