181例胆汁淤积型自身免疫性肝炎患者的临床特点分析

Clinical features of 181 patients with cholestatic autoimmune hepatitis

目的探讨胆汁淤积型自身免疫性肝炎(AIH)患者的临床特点及激素治疗转归情况。方法收集2014年1月-2015年12月于解放军第三〇二医院住院的AIH、自身免疫性肝炎肝硬化(AIH-LC)、自身免疫性肝炎肝衰竭(AIH-LF)患者,对符合纳入标准的胆汁淤积型AIH患者临床资料进行回顾性分析,并对激素治疗患者的好转率及未应用激素治疗的原因进行分析。正态分布的计量资料多组间比较采用单因素方差分析,非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ2检验。结果共纳入胆汁淤积型AIH患者181例,其中AIH组15例、AIH-LC组142例,AIH-LF组24例,男女比例1∶11.1,符合抗核抗体阳性和(或)抗平滑肌抗体阳性的1型AIH患者占96.7%(175/181)。胆汁淤积型AIH患者中以肝硬化所占比例最高(78.5%)。3组患者在年龄、Alb、PTA、ALT、AST、GGT、TBil水平比较差异均有统计学意义(F值分别为3.836、13.271、41.819;χ~2值分别为29.153、22.759、8.826、26.942,P值均<0.05)。181例胆汁淤积型AIH患者总体治疗好转率为36.5%,其中AIH组好转率最高(66.7%)。应用激素治疗的患者共35例,占19.3%,其治疗好转率显著高于未应用激素治疗患者(57.1%vs31.5%,χ~2=8.009,P=0.005)。感染、腹水和消化道出血是未应用激素治疗的主要原因。结论 AIH出现胆汁淤积以女性、肝硬化以及1型AIH者最为多见,且激素治疗有效,但其应用比例较低,感染、腹水和消化道出血是限制其应用的主要原因。

Objective To investigate the clinical features of patients with cholestatic autoimmune hepatitis（ AIH） and their prognosis after corticosteroid therapy. Methods The patients with AIH,autoimmune hepatitis-liver cirrhosis（ AIH-LC）,or autoimmune hepatitis-liver failure（ AIH-LF） who were hospitalized in 302 Hospital of PLA from January 2014 to December 2015 were enrolled,and a retrospective analysis was performed for the clinical data of the patients with cholestatic AIH who met the inclusion criteria. The improvement rate of patients receiving corticosteroid therapy and reasons why corticosteroid therapy was not applied were analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results A total of 181 patients with cholestatic AIH were enrolled,with 15 patients in AIH group,142 in AIH-LC group,and 24 in AIH-LF group. The male/female ratio was 1 ∶ 11. 1. Type-1 AIH patients with positive anti-nuclear antibody and/or anti-smooth muscle antibody accounted for 96. 7%（ 175/181）. Most patients with cholestatic AIH had liver cirrhosis（ 78. 5%）. There were significant differences between the three groups in age,albumin,prothrombin time activity,alanine aminotransferase,aspartate aminotransferase,gamma-glutamyl transpeptidase and total bilirubin（ F = 3. 836,13. 271,and 41. 819,χ~2= 29. 153,22. 759,8. 826,and 26. 942,all P 0. 05）. The 181 patients with cholestatic AIH achieved an overall improvement rate of 36. 5%,and the AIH group had the highest improvement rate（ 66. 7%）. Of all patients,35（ 19. 3%） received corticosteroid therapy,and these patients had a significantly higher improvement rate than those who did not receive corticosteroid therapy（ 57. 1% vs 31. 5%,χ~2= 8. 009,P = 0. 005）. Infection,ascites,and gastrointestinal bleeding were main reasons for the absence of corticosteroid therapy. Conclusion Cholestatic AIH is commonly seen in female patients,and most of patients with cholestatic AIH have liver cirrhosis or type-1 AIH. Corticosteroid therapy is an effective method,but its application is limited by infection,ascites,and gastrointestinal bleeding.