自身免疫性肝病合并胆囊结石的临床特征

Clinical characteristics of patients with autoimmune liver disease complicated with gallbladder stone

目的探讨自身免疫性肝病(AILD)患者合并胆囊结石的临床特征,以指导临床实践。方法回顾性分析2009年11月至2018年10月于天津医科大学总医院就诊的386例AILD患者的临床资料。根据相关诊断标准筛选出自身免疫性肝炎(AIH)208例、原发性胆汁性胆管炎(PBC)129例和PBC-AIH重叠综合征患者49例。分析AILD患者合并胆囊结石的比例、基本特征和实验室检查指标如白蛋白、ALP、GGT等的变化。应用卡方检验、t检验、秩和检验进行统计学分析。结果AILD、AIH、PBC和PBC-AIH重叠综合征患者合并胆囊结石的比例比较[分别为32.9%(127/386)、28.8%(60/208)、36.4%(47/129)和40.8%(20/49)],差异无统计学意义(P>0.05)。合并胆囊结石的AILD患者以多发和小结石(最大径<1 cm)为主,分别占45.7%(58/127)和57.7%(60/104)。合并胆囊结石的AILD患者首诊年龄、首诊肝硬化比例、ALP、GGT水平均高于未合并胆囊结石的AILD患者[分别为(60.5±11.5)岁比(57.6±11.5)岁,53.5%(68/127)比42.1%(109/259),154.00 U/L(89.00 U/L,257.00 U/L)比125.00 U/L(86.00 U/L,212.00 U/L),169.00 U/L(79.00 U/L,343.00 U/L)比128.60 U/L(48.00 U/L,284.00 U/L)],而白蛋白水平低于未合并胆囊结石者[(36.46±7.30)g/L比(38.34±7.58)g/L],差异均有统计学意义(t=-2.361,χ^2=4.506,Z=-2.192、-2.443,t=2.322;P均<0.05)。≥60岁AILD患者合并胆囊结石的比例高于<60岁患者[37.6%(73/194)比28.1%(54/192)],差异有统计学意义(χ^2=3.948,P=0.047)。伴肝硬化的AILD和AIH患者合并胆囊结石的比例均高于无肝硬化者[分别为38.4%(68/177)比28.2%(59/209),35.7%(35/98)比22.7%(25/110)],差异均有统计学意义(χ^2=4.506、4.259,P=0.034、0.039)。结论AILD患者合并胆囊结石较常见,以多发和小结石为主。合并胆囊结石易延误AILD患者的首次诊断并增高首诊肝硬化的比例。高龄和肝硬化AILD患者合并胆囊结石的比例更高。

Objective To explore the clinical characteristics of liver function of patients with autoimmune liver disease(AILD)complicated with gallbladder stone(GS),so as to guide clinical practice.Methods From November 2009 to October 2018,at General Hospital of Tianjin Medical University,the clinical data of 386 patients with AILD were retrospectively analyzed.According to the relevant diagnostic criteria,208 cases of autoimmune hepatitis(AIH),129 cases of primary biliary cholangitis(PBC)and 49 cases of PBC-AIH overlap syndrome were screened out.The incidence,clinical characteristics and the changes of laboratory indicators including albumin,alkaline phosphatase(ALP)andγ-glutamyl transferase(GGT)of AILD patients complicated with GS were analyzed.Chi-square test,t test and rank sum test were performed for statistical analysis.Results There was no significant difference in the incidence between AILD,AIH,PBC and PBC-AIH overlap syndrome patients complicated with GS(32.9%,127/386;28.8%,60/208;36.4%,47/129 and 40.8%,20/49;respectively;P>0.05).Gallstones of AILD patients complicated with GS mostly were multiple and small stones with maximum diameter<1 cm(45.7%,58/127 and 57.7%,60/104,respectively).The age of initial diagnosis,the proportion of liver cirrhosis at inital diagnosis and the levels of ALP and GGT were higher in AILD patients complicated with GS than those of AILD patients without GS((60.5±11.5)years vs.(57.6±11.5)years;53.5%,68/127 vs.42.1%,109/259;154.00 U/L(89.00 U/L,257.00 U/L)vs.125.00 U/L(86.00 U/L,212.00 U/L);169.00 U/L(79.00 U/L,343.00 U/L)vs.128.60 U/L(48.00 U/L,284.00 U/L);respectively);however the albumin level was lower than that of AILD patients without GS((36.46±7.30)g/L vs.(38.34±7.58)g/L),and the differences were statistically significant(t=-2.361,χ^2=4.506,Z=-2.192,-2.443,t=2.322;all P<0.05).The incidence of GS in AILD patients≥60 years old was higher than that AILD patients<60 years old(37.6%,73/194 vs.28.1%,54/192),and the difference was statistically significant(χ^2=3.948,P=0.047).The incidence of GS in AILD patients and AIH patients complicated with liver cirrhosis was higher than that in patients without liver cirrhosis(38.4%,68/177 vs.28.2%,59/209;35.7%,35/98 vs.22.7%,25/110;respectively),and the differences were statistically significant(χ^2=4.506 and 4.259,P=0.034 and 0.039).Conclusions AILD patients complicated with GS are common,most are multiple and small stones.When complicated with GS,the initial diagnosis may be delayed and the rate of liver cirrhosis at initial diagnosis may increase.The incidence of GS is high in AILD patients with older age and liver cirrhosis.