190例自身免疫性肝病临床特征分析

Analyses of the clinical features in 190 cases with autoimmune liver diseases

目的比较分析自身免疫性肝炎、原发性胆汁性肝硬化和重叠综合征的临床特征。方法回顾性分析自身免疫性肝炎、原发性胆汁性肝硬化和重叠综合征患者的临床症状、体征、生化检查、免疫球蛋白、自身抗体、肝脏组织学等检查。结果3组均以女性患者多见，以乏力、黄疸、瘙痒、脾大等为主要临床表现；3组患者白蛋白水平均下降，以原发性胆汁性肝硬化组下降最明显（P〈0．05）；3组患者总胆红素、直接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转氨酶、碱性磷酸酶和γ-谷酰转移酶均有升高，以重叠综合征升高最明显（P〈0．05）。结论自身免疫性肝病患者的临床特征可能对早期诊断有重要意义；肝功能总胆红素、直接胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转氨酶、碱性磷酸酶和γ-谷酰转移酶等指标升高明显者需警惕重叠综合征的存在。

Objective To analyze the clinical features among patients with autoimmune hepatitis （ AIH）, primary biliary cirrhosis （PBC） and overlap syndrome （AIH-PBC）. Method To retrospectively analyze the clinical symptoms, physical signs, biochemistry, immunoglobulin, autoantibody, histopathology in patients with autoimmune liver diseases （including 120 AIH,49 PBC and 21 AIH-PBC cases）. Results Women were affected more frequently than men. The most common symptoms were fatigue ,jaundice, pruri- tus and splenomegaly in the three groups. Serum albumin （ALB）levels decreased, especially in the PBC group. While the total bilirubin （ TBIL）, direct bilirubin （ DBIL ）, alanine aminotransferase （ ALT）, aspar- tate aminotransferase （AST）, serum alkaline phosphatase （ALP）and gamma-glutamyl transpeptidase （GGT） levels increased in the three groups,especially in the AIH-PBC group. Conclusion The clinical features might have significant importance on the early diagnosis of autoimmune liver diseases; If the TBIL,DBIL, ALT, AST, ALP, GGT levels were significantly higher, the presence of overlap syndrome should be alert.