30例自身免疫性肝炎患者临床与免疫学特点分析

Clinical and immunological characteristics of 30 patients with autoimmune hepatitis

目的分析比较30例自身免疫性肝炎(AIH)的临床与免疫学特点,以提高对其的认识。方法收集2008年8月—2012年9月确诊为AIH的住院患者30例,对患者的临床及免疫学特点进行回顾性分析。结果 AIH患者多发于中年女性(72.9%),常见症状为乏力、纳差、黄疸,另有发热、腹胀、恶心、呕吐等。体征有肝肿大,肝掌、蜘蛛痣,脾大、腹水、面色灰暗,皮疹等。AIH可以重叠原发性胆汁性肝硬化,常合并类风湿性关节炎、干燥综合征、2型糖尿病、骨质疏松、甲状腺功能亢进、过敏性鼻炎等其他类型自身免疫性疾病。AIH患者的发病年龄高峰在50岁左右,肝功能检查结果显示为丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、碱性磷酸酶、谷氨酰转肽酶异常、丙种球蛋白和免疫球蛋白G均明显高于正常值,66.7%的患者抗核抗体(ANA)阳性,另外还可出现抗平滑肌抗体(SMA)、抗线粒体抗体(AMA)、抗线粒体抗体亚型-Ⅱ(AMA-M2)、抗肝肾微粒体抗体(抗LAK)、抗肝特异性胞质抗原型1抗体(抗LC-1)、抗肝细胞膜抗体(抗LMA)、抗中性粒细胞胞浆抗体(ANCA)、抗可溶性肝脏抗原抗体(抗SLA)、抗核糖体抗体(抗RNP)、抗SSA、抗Sm抗体、抗SSB抗体等多种自身抗体。结论 AIH在中国人中并非少见,其诊断需综合临床表现、生化、免疫学指标等,肝穿刺活检病理学检查是确诊AIH的重要依据。

Objective To investigate the clinical and immunological characteristics of autoimmune hepatitis （AIH） and improve the diagnosis and treatment8 to September,2011 were enro of this disease. Methods Total 30 inpatients with AIH in our hospital from August, 200lled in this study, the clinical and immunological characteristics of patients were reviewed. Results The middle-aged women（72.9% ） were the high-risk population of AIH. The common symptoms were fatigue, anorexia,jaundice, fever, abdominal distension, nausea and vomiting, et al. The physical signs included hepatomegaly,liver palm, spider nevus, splenomegaly, ascites, gloomy complexion, skin rash. AIH may overlap with primary biliary cirrhosis, and commonly combine with rheumatoid arthritis, Sjogren syndrome, type 2 diabetes, osteoporosis, hyperthyroidism, allergic rhinitis and other types of autoimmune diseases. The peak age of onset of AIH patients was 50 years old. Their levels of alanine aminotransferase （ ALT）, aspartate aminotransferase （ AST）, total bilirubin （ TBil ）, alkaline phosphatase, gamma glutamyhransferase, gamma globulin and immunoglobulin G rose significantly. 66.7% of them were with positive anti-nuclear antibody （ANA）, and positive anti-smooth muscle antibody（ SMA）, anti-mitochondrial antibody（ AMA）, anti- mitochondrial antibody subtype Ⅱ （AMA-M2） ,liver kidney microsomal antibody （anti LAK） ,anti-liver specific cytoplasmic antibody （anti LC-1 ）, anti-liver cell membrane antibody（ anti LMA）, anti-neutrophil cytoplasmic antibody （ANCA）, anti-soluble liver antigen antibody （ anti SLA）, anti-ribosomal antibody （ anti RNP）, anti SSA, anti Sm antibody, anti SSB antibody and other autoantibodies in some cases. Conclusion AIH in Chinese is also common. The diagnosis of AIH should be based on clinical manifestations, biochemical and immunological indexes. The liver biopsy pathology examination is an important basis for the definite diagnosis of AIH.