自身免疫性肝炎与病毒性肝炎的临床病理特点对照研究

Comparalive study of elinical and pathological features between autoimmune hepatitis and viral hepatitis

目的了解自身免疫性肝炎（AIH）的临床与病理特点，提高AIH早期诊断的准确率。方法78例AIH患者分为急性发病和慢性发病两组，与31例急性病毒性肝炎（AH）、31例慢性乙型肝炎（CHB）肝功能娩疫球蛋白进行比较，并对急性发病AIH（急性AIH组）与慢性发病AIH（慢性AIH组）进行组间比较。部分患者进行肝组织活检病理和HBsAg免疫组化检查。结果本组78例AIH患者中，女性74例，占94．87％，发病年龄呈单峰分布，以40岁以上为主，占78．21％。AIH组的AST／ALT、γ-谷氨酰转肽酶（GGT）、碱性磷酸酶（ALP）、IgG、IgM和γ球蛋白水平明显高于CHB和AH组；慢性AIH组γ球蛋白水平明显高于急性AIH组（P〈0．05）。AIH患者抗平滑肌抗体阳性率仅6．41％，抗核抗体（ANA）阳性率为79：49％，急、慢性AIH两组间ANA滴度差异无统计学意义（P〉0．05）。在肝组织病理表现上，AIH患者与AH容易鉴别，但与CHB肝组织表现类似，主要为疏松变性、点状坏死和碎屑样坏死，大多伴有桥接坏死，汇管区以淋巴细胞浸润最为多见，伴有不同程度的纤维化。急、慢性AIH肝组织炎症和纤维化程度相仿（P〉0．05）。2例亚急性肝衰竭发病AIH患者肝组织病变程度与临床表现不符。结论AIH患者发病以40岁以上女性为主，常伴有AST／ALT、GGT、肿及以γ球蛋白为主的免疫球蛋白升高和自身抗体的出现。肝组织学表现多样，以碎屑样坏死伴大量淋巴细胞浸润、桥接坏死常见；急、慢性AIH肝组织病变程度相仿。肝组织学检查对早期正确诊断非常重要。

Objective To explore the character of clinical manifestations and liver pathological features of autoimmune hepatitis （AIH） and improve the diagnostic accuracy in early stage of AIH patients. Me.otis 78 patients with AIH,31 patients with acute viral hepatitis（AH） and 31 patients with chronic hepatitis B （CHB） were collected. The liver function and immunoglobulins were compared among them as well as the comparison of chronic and acute onset AIH groups. A part of patients underwent liver, biopsy and HBsAg immunohistochemistry examination. Results AIH patients were dominated by female （94.87%） over 40 years old （78.21%）. The level of AST/ALT, γ-glutamyl transferase （GGT）, alkaline phosphatase（MP）, IgG, IgM and γ-globulin in AIH group were significantly higher than those in CHB and AH groups. Furthermore, the level of y-globnfin in chronic AIH group was higher than that in acute onset AIH group （P 〈 0.05）. The positive rate of smooth muscle antibody（SMA） was 6.41%, and the positive rate of anti-nuclear antibody（ANA） was 79.49% in AIH patients. There was no difference in the titer of ANA between acute and chronic AIH groups（P〉 0.05）. Regarding the appearance of liver pathology, it was easy to distinguish AIH from AH, but difficult to differentiate AIH from CHB. Liver tissues, loose degeneration, spotty necrosis and piecemeal necrosis accompanying with bridging necrosis were very common in AIH. There were great numbers of lymphocyte infiltration in portal area that was often accompanied with varying degrees of frbmsis. The degree of hepatic inflammation and fibrosis were similar in acute and chronic AIH （ P 〉 0.05）. The degree of hepatic lesions in 2 AIH patients suffered with subacute liver failure didn＇ t agree with the severe clinical manifestations. Conclusions AIH patients are dominated with female over 40-year-old who often accompanied with elevation of AST/ALT, GGT, ALP and γ-globulin as well as the appearance autoantibodies. The appearance of liver pathology is multiplicity that piecemeal of necrosis accompanying with bridging necrosis and lymphocytes infiltration is common. The degree of hepatic lesions is similar in acute and chronic AIH. It＇ s important to check the liver tissue for diagnose in early stage correctly.