自身免疫性肝病148例临床特点分析

Analyses of 148 cases of autoimmune liver diseases

目的分析自身免疫性肝病(autoimmune liver diseases,ALDS)的临床、生化及自身抗体特点。方法分析我院1996年-2005年148例ALDS患者其中自身免疫性肝炎(autoimmune hepatitis,AIH)患者52例,原发性胆汁性肝硬化(primary biliary cirrhosi,PBC)患者96例的临床表现,并分析有关实验室检查资料。结果两组患者临床症状均不典型,肝功能各项指标普遍异常,AIH组以ALT升高更为明显,而PBC组患者ALP和GGT升高更为显著(P<0.01)。在自身抗体检测情况两组有极大的差异。AIH患者主要以高效价的抗核抗体(antinuclear antibodies,ANA)(44/52)和/或抗平滑肌抗体(antismooth muscle antibodies)(35/52)为主,此外,尚有9.6%(5/52)和3.8%(2/52)的AHI患者出现抗可溶性肝抗原抗体(auti-soluble liver antigen autoantibdies,抗SLA)和抗肝/肾微粒体(liver/kidney microsomal,LKM)抗体阳性。PBC组以抗线粒体抗体(mitahondrial anto-antibodies,AMA)阳性(99.0%)为主,93.8%的患者AMAM2阳性。结论AIH及PBC的诊断可结合临床、生化、自身抗体检查的结果,其中自身抗体的检测尤为重要。

Objective To study the clinical, biochemical, immunological features of autoimmune liver diseases（ALDS） .Methods Clinical and laboratory data of 148 patients（from 1996 to 2005）with ALDS（52 cases with AIH,96 cases with PBC were retrospectively analyzed. Results The patients of ALDS in our group, did not exhibit typical manifestations and the liver function exhibited abnormal. Alanine aminotransferase（ALT） was markedly elevated in the patients with AIH. Serum glutamyl transpeptidase（GGT） and alkaline phosphatase（ ALP） was markedly elevated in the patients with PBC,There was significant difference between AIH and PBC in the presence of autoanfibodies.44 cases expressed positive ANA, 35 SMA,5 anfi-SLA and 2 anfi-LKM-1 in those 52 patients with AIH. 95 cases expressed positive AMA, 90 AMA M2 in the patients with PBC. Conclusion The pa. fients with ALDS could be diagnosed by investigation of clinical features and detection of autoantebodies detection. The autoantibodies detection was very important in the diagnosis of ALDS.