自身免疫性肝炎46例

Autoimmune hepatitis: an analysis of 46 cases

目的:分析老年人自身免疫性肝炎(autoimmune hepatitis,AIH)的临床、生化、免疫学及治疗转归等特征.方法:按照国际自身免疫性肝炎小组(international autoimmune hepatitis group,IAIHG)修订的诊断标准,对2005-01/2009-06期间确诊的AIH患者46例进行回顾性分析,比较老年(≥60岁)和中青年(<60岁)患者的一般资料、临床表现、生物化学、免疫学、首诊确诊率及转归等特征.结果:AIH患者46例中,21例老年患者的临床表现和中青年患者相似,以乏力、体质量下降、黄疸、肝脾大为主要特征,老年组出现肝硬化发生率高于中青年组(57.1%vs12.0%,P<0.01);老年组的首诊确诊率低于中青年组(28.5%vs56.0%,P<0.05);老年组伴发其他自身免疫性疾病高于中青年组(52.3%vs17.4%,P<0.01).老年组ANA、SMA、AMA-M2、SSA/SSB检出率分别为61.9%、14.3%、23.8%、23.8%;中青年组ANA、SMA、LKM1、SLA、AMA-M2、SSA/SSB、Sm、pANCA检出率分别为65.2%、26.0%、4.3%、4.3%、4.3%、4.3%、4.3%、4.3%;首次血液生化检验结果显示,两组患者均以γ-GT、ALT、AST、IgG、血清胆红素升高为主,其中γ-GT、血清胆红素、IgG、IgM水平老年组较中青年组升高更明显,两组比较具有显著性差异(均P<0.05或0.01);两组患者随诊24wk后血液生化检验结果显示,大部分患者免疫应答良好,中青年患者改善程度好于老年患者,两组比较具有显著性差异(P<0.05或0.01).结论:老年患者肝脏损害严重、转归慢与其病程长、确诊晚有关;误诊或漏诊成为延误早期治疗的主要原因,应引起临床医生的重视.

AIM： To analyze the clinical,biochemical and immunological features,treatment,and outcome of autoimmune hepatitis （AIH） in elderly patients.METHODS： Forty-six patients with AIH diagnosed from January 2005 to June 2009 according to the diagnostic criteria revised by international autoimmune hepatitis group （IAIHG） were included in this study.These patients were divided into two groups： those ≥60 years （n = 21） and those 60 years （n = 25）.The general information,clinical,biochemical and immunological features,initial diagnostic accuracy,and outcome in these patients were retrospectively analyzed.RESULTS： Elderly and younger AIH patients shared similar clinical manifestations,mainly including fatigue,body mass loss,jaundice,and hepatosplenomegaly.Compared with younger patients,elderly ones had higher incidence of cirrhosis （57.1% vs 12.0%,P 0.01） and morbidity of associated autoimmune diseases （52.3% vs 17.4%,P 0.01）,but lower initial diagnostic accuracy （28.5% vs 56.0%,P 0.05）.The detection rates of ANA,SMA,AMA-M2 and SSA/SSB in elderly patients were 61.9%,14.3%,23.8% and 23.8%,respectively,while those of ANA,SMA,LKM1,SLA,AMA-M2,SSA/SSB,Sm and pANCA in younger patients were 65.2%,26.0%,4.3%,4.3%,4.3%,4.3%,4.3% and 4.3%,respectively.Both groups of patients showed increased serum γ-GT,ALT,AST,IgG and bilirubin at initial diagnosis.The increase in the levels of serum γ-GT,bilirubin,IgG and IgM was more significant in elderly patients than in younger ones （all P 0.05 or 0.01）.At 24 wk of follow-up,biochemical blood tests showed that the majority of patients had excellent immune response,and better improvement in immune response was achieved in younger patients than in elderly ones （P 0.05 or 0.01）.CONCLUSION： Long course of disease and late diagnosis are associated with severe liver damage and slow recovery in elderly AIH patients.Misdiagnosis or missed diagnosis is the main reason for delayed treatment of AIH.