天津医药

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自身免疫性肝炎39例临床分析

刘均娟1,张俊霞2   

  1. 1. 天津市传染病医院
    2. 天津医科大学
  • 收稿日期:2012-02-20 修回日期:2012-05-11 出版日期:2012-07-15 发布日期:2012-07-15
  • 通讯作者: 张俊霞

Clinical characteristics of 39 autoimmune hepatitis patients

  • Received:2012-02-20 Revised:2012-05-11 Published:2012-07-15 Online:2012-07-15

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摘要： 目的:分析自身免疫性肝炎（autoimmune hepatitis, AIH）患者临床表现、生化、免疫学及病理学特点，以期提高诊断率和减少漏诊率。方法:采用国际自身免疫性肝炎小组制订的AIH的诊断积分系统，回顾性分析39例确诊为AIH患者的临床、实验室检查及肝脏病理。以同期住院的40例急性乙型肝炎（急乙肝）患者作为对照观察。结果:AIH多见于女性（97.4%），45~59岁占76.9%。急乙肝则以45岁以下（85%）的男性(72.5%)多见。 15例（38.5%）AIH患者同时合并其他自身免疫性疾病，10例（25.6%）的一级亲属同时患有自身免疫性疾病。15例（38.5%）AIH患者γ-谷氨酰转肽酶(γ-GT)大于正常值上限10倍，与急乙肝比较差异有统计学意义（216.4±158.5 vs 83.4±30.5, P <0.05)。其中8例（20.5%）在ALT下降时γ-GT反而继续升高。AIH组抗核抗体(ANA)阳性率最高，有4例（10.3%）自身抗体全部阴性。肝组织病理变化以界面性炎症（65.6%）为主。结论:对怀疑AIH的患者应关注一级亲属自身免疫性疾病发病情况，血清γ-GT高水平及随ALT下降反而继续升高有助于AIH的诊断。

关键词: 自身免疫性肝炎, 自身抗体, γ-GT, 一级亲属, 诊断

Abstract: Abstract Object: To summarize the clinical，pathological, immunnological and biochemical features of autoimmune hepatitis(AIH), to improve the rate of diagnosis and decrease the rate of missed diagnosis. Methods: Adopted the descriptive diagnosis standard and scoring system proposed by International Autoimmune Hepatitis Group. 39 cases with AIH were retrospectively analyzed and the clinical manifestations and laboratory examinations were investigated. 40 in-hospital patients of acute hepatitis B patients in the same period were selected as a comparison. Results: Most of AIH patients were the female (97.4%), mainly ranged in age from 45 to 59 (71.8%). Most of acute hepatitis B were male (72.5%) and lessed than 45 years old (85%). In AIH patients, 15 cases (38.5%) were accompanied by other autoimmune diseases. The first-degree relatives of 10 (25.6%) AIH patients were associated with autoimmune diseases. The level of γ-glutamyl transpeptidase (γ-GT) in AIH patients was higher than acute hepatitis B(216.4±158.5 vs 83.4±30.5, P <0.05). The level of γ-GT were greater than 10 times of upper limited normal (ULN) in 15 cases（38.5%）of AIH, and Continuously increased in 8 （20.5%）AIH cases in late stage when ALT has already decreased. The autoantibody positive rate of ANA was high in AIH group, but there are still 4 (10.3%) patients were autoantibodies negative. The main histologic change was interface hepatitis(65.6%). Conclusion: Carefully questioning the history of autoimmune diseases in the first-degree relatives and observing the change of γ-GT can help the diagnosis of AIH.

Key words: Autoimmune hepatitis, Autoantibody, γ-glutamyl transpeptidase, First-degree relatives, Diagnosis