自身免疫性肝炎20例临床分析

Clinical characteristics of 20 autoimmune hepatitis patients

目的了解自身免疫性肝炎(AIH)患者的临床、免疫学和病理学特点。方法按照国际自身免疫性肝炎小组(IAIHG)新修订的诊断标准,回顾性的分析该院2003～2007年20例AIH患者的临床、免疫学、病理学特点及治疗应答等。结果20例AIH患者,发病年龄(50.57±14.85)岁,临床表现主要为乏力、黄疸、发热、恶心和腹胀等。肝功能表现为肝炎样异常,合并其他自身免疫性疾病25.0%。免疫学检测显示γ球蛋白和IgG升高明显,自身抗体检出不同类型16种,以抗核抗体、抗平滑肌抗体、抗线粒体和抗SSA抗体多见。AIH亚型以Ⅰ型多见。肝活检5例,均见不同形式的肝细胞变性、坏死和浆细胞浸润,重度患者存在不同程度桥接坏死和纤维组织增生。结论AIH患者女性多见,发病和临床表现无特异性,生化检查以肝细胞损害为主,外周血出现多种自身抗体,组织学损害以界面性肝炎为主,免疫治疗有效。

【Objective】To summarize the clinical,immunnological and pathological features of autcimmune hepatitis（AIH）.【Methods】According to the revised criteria for diagnosis of autoimmune hepatitis proposed by the International Autoimmune Hepatitis Group,20 cases of patients with AIH were selected and the clinical manifestations,pathological change and response to therapy were investigated. 【Results】Most of AIH patients were women,with a age of （50.57±14.85） years old,and the ratio of female was 1∶10. The main clinical manifestations included fatigue,inappetence,jaundice,fever nausea,and abdominal swell,etc. AIH patients complicateted with other autoimmune diseases covered 25.0%. Biochemical examination showed elevated levels of alanine aminotransferase,and total bilirubin. High level of γ-globulin and immunoglobulin G were tested in most patients. The percentages of patients with Type 1 AIH and Type 2 AIH were 60% and 10%. A total of 16 kinds auto-antibodies were detected,including ANA,SMA AMA anti-SSA,etc. Hepatocyte denaturation,necrosis and plasmocyte infiltration were demonstrated in all of the 5 patients received liver biopsy,bridging necrosis and fibrosis,were observed in heavy cases. 【Conclusions】AIH occurred more frequently in females,and the onset and clinical features are not typical. Type 1 AIH is the most common one. There are many categories of antibodies in AIH. Hepatocyte denaturation,necrosis,plasmocyte infiltration and fibrous proliferation are dominant histological features. Immunosuppressive therapy is effective on autoimmune hepatitis.