50例急性重症自身免疫性肝炎患者临床特征和预后评价  

Clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis

作　　者：司进枚 王茜[2] 陈民 徐小国 姬会春 SI Jin-mei;WANG Qian;CHEN Min;XU Xiao-guo;JI Hui-chun(Department of Infectious Diseases,Shuyang Hospital Affiliated to Xuzhou Medical University,Jiangsu 223600,China;Department of Infectious Diseases,Jiangsu Provincial People’s Hospital,Nanjing 210000,China;Department of Infectious Diseases,Suqian First People’s Hospital Affiliated to Nanjing Medical University,Jiangsu 223800,China)

机构地区：[1]徐州医科大学附属沭阳医院感染科,江苏223600 [2]江苏省人民医院感染科,南京210000 [3]南京医科大学附属宿迁第一人民医院感染科,江苏223800

出　　处：《肝脏》2025年第1期107-111,共5页Chinese Hepatology

基　　金：宿迁市科研专项项目(SY202420)。

摘　　要：目的分析50例急性重症自身免疫性肝炎患者临床特征和预后评价。方法回顾性分析2015年1月—2023年1月我院收治的50例急性重症自身免疫性肝炎患者的临床资料,分析其临床特征,激素治疗1个月后根据预后结局分为存活组(n=40)和死亡组(n=10),比较两组临床特征,应用logistic回归模型分析影响急性重症自身免疫性肝炎患者预后结局的危险因素。结果50例急性重症自身免疫性肝炎患者中,38例(76.0%)为30~60岁,46例(92.0%)为女性,41例(82.0%)抗核抗体呈阳性,伴随多项实验室检查指标改变(白蛋白降低,总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、血小板计数、白细胞计数、免疫球蛋白G升高),组织学表现以淋巴细胞浸润、肝小叶坏死、肝纤维化为主,死亡风险较大(10例,20.0%)。死亡组终末期肝病模型(model for end-stage liver disease,MELD)评分、总胆红素水平、白细胞计数[(25.8±6.2)分、(393.5±25.1)μmol/L、(5.8±1.3)×10^(9)/L]均高于存活组[(19.4±4.2)分、(242.6±18.7)μmol/L、(3.9±0.7)×10^(9)/L](P<0.05)。logistic回归分析显示,MELD评分、总胆红素水平、白细胞计数是影响急性重症自身免疫性肝炎患者预后结局的危险因素(OR=5.249、5.191、4.918,P<0.05)。结论急性重症自身免疫性肝炎具有一定的临床特征,多发于中年女性,伴随多项实验室检查指标改变,抗核抗体呈阳性,组织学表现以淋巴细胞浸润、肝小叶坏死、肝纤维化为主,死亡风险较大,临床可依据MELD评分、总胆红素水平、白细胞计数来预测患者预后结局。Objective To analyze the clinical features and prognostic evaluation of 50 patients with acute severe autoimmune hepatitis.Methods A retrospective analysis was conducted on the clinical data of 50 patients with acute severe autoimmune hepatitis admitted to our hospital from January 2015 to January 2023.Their clinical characteristics were analyzed.After one month of hormone treatment,they were divided into a survival group(n=40)and a death group(n=10)based on the prognosis.The clinical characteristics of the two groups were compared,and logistic regression models were used to analyze the risk factors affecting the prognosis of patients with acute severe autoimmune hepatitis.Results Among the 50 patients with acute severe autoimmune hepatitis,38(76.0%)were aged 30-60 years old,46(92.0%)were female,and 41(82.0%)were positive for antinuclear antibodies,accompanied by changes in multiple laboratory indicators(decreased albumin,increased total bilirubin,alanine aminotransferase,aspartate aminotransferase,platelet count,white blood cell count,and immunoglobulin G).The histological manifestations were mainly lymphocyte infiltration,hepatic lobular necrosis,and liver fibrosis.Moreover,the mortality risk was elevated(10 cases,20.0%).Model for end-stage liver disease(MELD)score,total bilirubin level,and white blood cell count in the death group[(25.8±6.2)points,(393.5±25.1)μmol/L,(5.8±1.3)×10^(9)/L]were higher than those in the survival group[(19.4±4.2)points,(242.6±18.7)μmol/L,(3.9±0.7)×10^(9)/L](P<0.05).Logistic regression analysis showed that MELD score,total bilirubin level,and white blood cell count were risk factors affecting the prognosis of patients with acute severe autoimmune hepatitis(OR=5.249,5.191,4.918,P<0.05).Conclusion Acute severe autoimmune hepatitis exhibits specific clinical characteristics,often occurring in middle-aged women,accompanied by changes in multiple laboratory examination indicators,positive anti nuclear antibodies,and histological manifestations mainly characterized by lymphocyte i

关 键 词：急性重症 自身免疫性肝炎 临床特征 预后评价 

分 类 号：R575.1[医药卫生—消化系统]