8例自身免疫性肝炎病理学分析

Pathological Characterization of AIH in 8 Cases of AIH

目的 探讨自身疫性肝炎的病理组织学特点。方法 回顾性分析和研究 8例自身免疫性肝炎 (AIH)的临床资料、肝脏活检组织病理学、肝炎病毒免疫荧光检查结果。结果 8例临床诊断为AIH病例均为女性 ,年龄 16～ 72岁 ,临床表现主要包括发热、关节疼痛、皮疹或黄疸。多数伴有类风湿性关节炎等其他自身免疫性疾病表现。实验室检查 :γ球蛋白、ALT和AST等均有不同程度升高 ,且多数病例为自身抗体 [RF和 (或 )ANA]阳性。血清学肝炎病毒标志物均为阴性。肝组织病理变化主要为轻、中度慢性肝炎 (小叶性肝炎居多 ) ,肝细胞点状坏死、碎片状坏死、桥接样坏死多见 ,汇管区纤维组织增生和炎症细胞浸润。免疫荧光检查 :多数病例中可在肝细胞膜、汇管区和肝血窦等处见不同程度的IgG等免疫复合物沉积 ;2例有HBsAg阳性。 结论 我国该组AIH病例的肝组织病理学改变主要表现为慢性肝炎 ,病变具有特征性但无特异性 ,肝活检组织病理学和免疫荧光检查对AIH的诊断和鉴别诊断 ,尤其是对于变异型AIH的诊断具有重要意义 ,有助于指导临床治疗 。

Purpose: To study the clincal and pathological characterization of autoimmune hapatitis(AIH) cases. Methods: The clinical data, the results of pathological examination, immunofluorescence staining observation of the liver biopsy tissue of 8 AIH cases were investigated retrospectively. Results: All of 8 patients were female and were diagnosed as type I AIH. The main symptoms included fever, arthrodynia, purpura or jaundice. Most of cases were companied with other autoimmune diseases and were positive for RF or/and ANA antibodies. The titer of gamma globulin, ALT and AST was increased. The chronic hepatitis was the main histologic change, in which the minor to moderate degree was in most cases with spotty, piecemeal and bridging necrosis of liver tissue, inflammatory infiltration and fibrosis processing in portal area. In 5 cases IgG was detected by immunofluorescence assay, and in 2cases HBsAg was positive. Conclusions: The histologic and immunofluorescence examination are necessary for the diagnosis of AIH and can be helpful especially in the diagnosis of the variant type of AIH.