自身免疫性肝炎42例临床分析

Clinical characteristics of 42 autoimmune hepatitis patients

目的分析自身免疫性肝炎(autoimmune hepatitis,AIH)患者临床表现、生化、免疫学及病理学特点,以期提高诊断率和减少漏诊率。方法采用国际AIH小组制订的描述性诊断标准和计分系统,对42例确诊为AIH患者的临床、实验室检查进行回顾性分析。另选同期住院的40例急性乙型肝炎(急乙肝)患者作为对照。结果 AIH多见于女性(97.7%),>50～60岁占76.2%。急乙肝则以40岁以下(75.0%)的男性(72.5%)多见。15例(35.7%)AIH患者同时合并其他自身免疫性疾病,10例(23.8%)家族成员同时患有自身免疫性疾病。AIH和急乙肝均以丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)升高为主,分别为(808.8±532.1)U/L vs(810.2±523.4)U/L;(750.2±591.4)U/L vs(746.8±602.3)U/L(P>0.05)。AIH组以γ-谷氨酰转肽酶(γ-GT)明显升高为特征,大于正常值上限10倍者15例(35.7%),11例(26.2%)在ALT逐渐下降中反而继续升高。急乙肝组γ-GT仅轻度升高,与AIH组比较差异有统计学意义(221.0±163.5)U/L vs(85.7±23.4)U/L(P<0.05)。AIH组抗核抗体阳性率最高,有6例(14.3%)自身抗体全部阴性。急乙肝仅1例(2.5%)自身抗体阳性。结论结合临床症状、免疫学、生化指标及病理特点可提高AIH的诊断率。仔细询问合并症及家族史,同时观察γ-GT的变化有助于AIH的诊断。

Objective To summarize the clinical, pathological, immunological and biochemical features of autoimmune hepatitis（AIH） patients,to improve the diagnosis rate and decrease the missed diagnosis rate. Methods According to the descriptive diagnosis standard and scoring system proposed by International Autoimmune Hepatitis Group,42 cases with AIH were retrospectively analyzed and the clinical manifestations and laboratory examinations were investigated. 40 in-hospital patients of acute hepatitis B patients in the same period were selected as comparison. Results Most of AIH patients were the female（97.7%） ,main range in age from 50 to 60 years old（76.2%）. Most of acute hepatitis B were the male（72.5%） ,main range in age less than 40 years old （75.0%）. In AIH patients,15 cases （35.7 %） were accompanied by other autoimmune diseases, the members of the 10 patients （23.8 % ） were associated with autoimmune diseases. AIH and acute hepatitis B both had markedly higher serum alanine transaminase（ALT） and aspartate aminotransferase（AST）,respectively （808.8±532.1） U/L vs （810.2±523.4） U/L;（750.2±591.4） U/L vs （746.8±602.3） U/L（ P 〉0.05）. But the increase of γ-glutamyl transpeptidase（γ-GT） was more prominent in patients of AIH than acute hepatitis B,15 cases（35.7%） of AIH were greater than 10 times of upper limited normal （ULN）, γ-GT increased in 11 AIH cases（26.2 % ） in late stage when ALT had already decreased. But at the same time, γ-GT level showed only mild increase in patients of acute hepatitis B, the difference had statistical significance （221.0 ± 163.5） U/L vs （85.7 ± 23.4） U/L（ P 〈0.05）. The autoantibody positive rate of antinuclear antibody was high in AIH group,but there were still six patients（14.3%） whose autoantibodies were negative. Autoantibody positive was found only in 1 patients （2.5%） with acute hepatitis B. Conclusion The combination of clinical symptoms, the biochemical and immunological indicators can greatly improve the diagnosis of AIH. Carefully questioning the complications,family history and observing the change of γ-GT can help the diagnosis of AIH.