自身免疫性肝炎-原发性胆汁性肝硬化重叠综合征的临床特点及诊断分析

Clinical features and diagnosis of autoimmune hepatitis-primary biliary cirrhosis overlap syndrome

目的分析自身免疫性肝炎(AIH)-原发性胆汁性肝硬化(PBC)重叠综合征患者临床特点、实验室结果、诊断正确率及时长。方法选取2009年1月至2013年6月经过肝活组织病理检查明确诊断为AIH-PBC重叠综合征的患者53例,对照组为AIH及PBC患者各53例。对患者的临床表现、实验室结果及入院后诊断情况进行回顾分析。正态分布的定量资料采用单因素方差分析对各组间进行比较,两两比较采用SNK-q检验。定性资料采用R×C列联表法进行各组间比较,两两比较采用Scheffe可信区间法。结果 53例AIH-PBC重叠综合征患者ALT为(173.65±52.08)U/L,血清TBil为(38.07±6.82)μmol/L,ALP为(293.81±28.89)U/L,GGT为(57.57±78.84)U/L。其中ALP较两个对照组差异有统计学意义;血清免疫球蛋白IgM为(3.33±2.12)g/L,较两个对照组差异具有统计学意义。自身抗体中抗线粒体抗体M2亚型(AMA-M2)(27/53)较两对照组差异具有统计学意义;未经肝活组织检查诊断正确率(52.83%)最低、入院后明确诊断需要时间最长[(8±7.7)d]。结论 AIH-PBC重叠综合征临床表现更类似于PBC,但生化检查结果更类似于AIH,AIH-PBC重叠综合征兼有AIH和PBC的双重特点。

Objective To analyze the clinical features and laboratory test results of patients with autoimmune hepatitis （AIH）-primary biliary cirrhosis （PBC）overlap syndrome,as well as their correct diagnosis rate and time to diagnosis.Methods Fifty-three patients who were diagnosed by liver biopsy as having AIH-PBC overlap syndrome from January 2009 to June 2013 were selected as subjects;53 AIH patients and 53 PBC patients were selected as control groups.Their clinical manifestations,laboratory test results,and diagnosis on admission were retrospectively analyzed.Comparison of normally distributed quantitative data between groups was made by one-way analysis of variance,and multiple comparisons were made by SNK-q test;comparison of qualitative data between groups was made using R ×C contin-gency table,and multiple comparisons were made by Scheffe′s confidence interval test.Results The 53 patients with AIH-PBC overlap syndrome had a serum alanine aminotransferase level of 173.65 ±52.08 U/L,a serum total bilirubin level of 38.07 ±6.82 μmol/L,a ser-um alkaline phosphatase （ALP）level of 293.81 ±28.89 U/L,and a serum gamma-glutamyl transpeptidase level of 57.57 ±78.84 U/L. ALP showed significant difference between the patients with AIH-PBC overlap syndrome and control groups.The serum level of immuno-globulin Min overlap syndrome patients was 3.33 ±2.12 g/L,which was significantly different from those of two control groups.Of the 53 overlap syndrome patients,27 were positive for anti-mitochondrial antibody-M2,and the positive rate was significantly different from those of two control groups.Without liver biopsy,the correct diagnosis rate was the lowest （52.83%）,and it took the longest time （8 ±7.7 d） to confirm the diagnosis on admission.Conclusion The clinical manifestations of patients with AIH-PBC overlap syndrome are more similar to those of PBC patients,but their biochemical test results are more similar to those of AIH patients.AIH-PBC overlap syndrome has the clinical features of both AIH and PBC.