64例自身免疫性肝炎患者临床资料回顾性分析

Retrospective analysis of clinical data on 64 patients with autoi-mmune hepatitis

目的:对我院收治的自身免疫性肝炎(AIH)患者临床资料进行分析、归纳、总结,探讨AIH患者的临床特点。方法:采用回顾性方法收集2003年1月至2008年12月在我院住院的AIH患者的临床资料,并对其进行分析。结果:①本次调查共收集病历64例。男女比例为1:3.57,女性患者多见。②患者的发病诱因主要为:胆囊及胆道疾病、慢性肝炎、脂肪肝、脾脏疾病、呼吸道感染、输血、情绪精神异常等。③临床表现:患者临床症状无明显特异性,多以乏力、纳差、黄疸、发热、恶心、腹胀及肝功能异常为首发及主要症状。④64例患者多数存在肝功能受损现象,少数患者伴有轻度凝血功能异常。在行免疫球蛋白检查的26名患者中有16人IGG水平升高。64例患者中87.27%是Ⅰ型AIH,这一比率要高于以往发布的AIH流行病学调查的结果。⑤影像学检查不具有特异性,可出现以下改变:脾大、肝硬化、肝脏肿大、脂肪肝、门静脉增宽、脾静脉增宽、升主动脉增宽、胆囊肿大和胆汁淤积。⑥病理学检查出现以下改变:汇管区炎性细胞浸润、界面性肝炎/肝细胞碎屑样坏死、肝细胞水样变、肝细胞气球样变、窦周细胞周纤维化、汇管区扩大、肝细胞嗜酸性变、中央静脉纤维化、胆管增生、汇管区纤维组织增生和胆管破坏。结论:AIH以中年女性为高发人群,83.64%的患者出现自身抗体ANA阳性。与其他病因所致肝炎相比,AIH临床症状不具有特异性,需要根据临床症状、肝功能并结合自身抗体检查和/或肝穿刺活检才可对本病作出明确诊断。Ⅰ型AIH患者占87.27%,这一比率要高于以往发布的AIH流行病学调查的结果,值得进一步研究。

Objective： To investigate the clinical features of AIH by analyzing the clinical data of 64 cases with autoimmune hepatitis. Methods： We collected 64 patients with autoimmune hepatitis through reviewing analysis who were admitted to the Union Hospital of Huazhong University of Science and Technology from 2003 to 2008. Results： 1, This study collected 64 cases with autoimmune hepatitis. Am- ong them, 50 were females and 14 were males.The ratio of men and women is 1：3.57.2, The inducing factor of AIH is as follows：the cases of the gallbladder and biliary tract diseases, chronic hepatitis, exogenous pathogenic factor, diseases of spleen, hepatic adipose infiltration, blood transfusions, emotional factor and so on. 3, Clinical symptoms were not obvious, The first or main symptom ofpatients is fatigue, an- orexia, jaundice, fever, nausea, abdominal distension and abnormal liver function.4, The majority of cases have abnormal liver function and some patients experience mild dysfunction of coagulation. ANA positive was present in 83.64 % of cases.5, Ultrasound examination in AIH patients has no specificity.The following radiological films occur in patients ：splenomegaly, enlargeme-nt of the liver, hepatocirrhosis, the dilation of portal vein and splenic vein, the dilation of ascending aorta, gallbladder enlargement and cholestasis, hepatic adipose infiltration. 6, The tissues presented with some pathological changes including lymphoplasmacytic infiltration and dilate of portal triads, piecemeal necrosis of liver cells, hydropic degeneration of liver cells, ballooning degeneration of liver ceils, fibrosis of central veios and perisinusoidal cells weeks, dilate of portal triads, eosinophilic change of liver cells, proliferation of bile vesse, fibroplastic proliferation of portal area and disrup- tion or proliferation of bile vesse. Conclusions： Autoimmune liver disease is a chronic liver disease and this disease occurs at high frequency among middle-aged women.AIH has no specific clinical symptoms. The diagnosis of this disease is based on the clinical symptoms, functioning power of liver and autoantibodies screening.