自身免疫性肝病20例临床分析

Clinical Study of 20 Cases with Autoimmune Hepatitis

目的:比较自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)和慢性乙型肝炎的临床特点,以利于临床早期鉴别诊断.方法:分析20例自身免疫性肝病临床资料,并将其与同期20例慢性乙型肝炎进行比较.结果:PBC肝功能异常以碱性磷酸酶、γ-谷氨酰转肽酶和总胆红素升高为特点,转氨酶水平低于AIH和慢性乙型肝炎;后两者肝功能异常无统计学差异.PBC免疫学指标以IgM升高为特点;AIH和慢性乙型肝炎亦有IgG升高,但两者相比无明显差异.自身免疫性肝病血液循环中可出现多种自身抗体,其中PBC以抗线粒体抗体(AMA),尤其AMA-M2为主;AIH循环自身抗体以抗核抗体(ANA)、抗平滑肌抗体(SMA)为主.肝穿刺病理学检查显示:PBC胆管损伤、炎症、淤胆明显;AIH以汇管区浆细胞浸润为主要特征;慢性乙型肝炎以肝细胞变性坏死明显;但总体而言,三者病理上并无可确诊的形态学改变.结论:自身免疫性肝病与慢性乙型肝炎临床表现、肝功能检查及病理皆有许多相似之处,但仍然有其各自特异的临床诊断依据,治疗方法也有明显不同.

The article analyzed the clinical features of 8 cases AIH and 12 cases PBC, compared them with 20 cases chronic hepatitis B in the same time. The purpose of this study was to reduce the ratio of misdiagnosis and increase survival rate. The results indicated that the clinical features of the 3 groups may overlap. Jaundice and scratch were often seen in PBC patients. Frequently, AIH and PBC were complicated with some other autoimmune diseases, such as hyperthyroidism, rheumatoid arthritis, diabetes mellitus etc. Alkaline phosphatase （ALP）, gamma-glutamy transpeptidase （GGT） activity and total bilirubin （TBIL） concentration were usually elevated distinctively in PBC. Alanine aminotransferase （ALT） and aspartate aminotrans-ferase （AST） were lower in PBC than that in AIH and chronic hepatitis B, the latter two diseases presented similar appearance at the liver function. There were some variation in their immunologic assay. Almost all patients with PBC had an elevated IgM concentration. IgG concentration was also increased in those patients with AIH and chronic hepatitis B, and IgG level presented a similar appearance. Many autoantibodies could be found in autoimmune liver diseases. Antibodies against mitochondria （AMA）, especially AMA-M2 were characterized of PBC. Patients with autoimmune hepatitis often had antinuclear antibodies （ANA） and/or anti-smooth muscle antibodies （SMA）. Liver biopsy showed some features. PBC was characterized of the florid duct lesion, ductular proliferation, fibrosis and biliary irrhosis. Interface hepatitis and plasma cell infil- tration were the most distinctive pathological features of AIH . Chronic hepatitis B was marked by degenerative and necrotic liver cell . But these changes could be seen in other liver diseases. So these finding alone were not significant for diagnosis. Conclusion： Though the three diseases have common phenomenon in clinical symptom, hepatic function examination and pathological patency, also have themselves＇ features . The therapy for each is very distinctive .