儿童自身免疫性肝炎临床特点及疗效分析

Analysis of clinical characteristics and curative effect of autoimmune hepatitis in children

目的探讨自身免疫性肝炎(AIH)患儿的临床特点及疗效。方法选取2014年6月至2019年6月西宁市中医院收治的AIH患儿22例。泼尼松2 mg/(kg·d)(最大剂量60 mg/d)治疗1个月后予硫唑嘌呤2 mg(kg·d)(最大100 mg/d),治疗3个月后逐步减少激素药物剂量直至停止。组间比较采用t检验、Kruskal-Wallis H检验和卡方检验。结果22例AIH患儿中表现为6例急性病程,10例亚急性病程,6例慢性病程。13例为AIH I型,5例为AIH II型,4例为未分型,三组分型患儿一般资料之间均差异无统计学意义(P>0.05)。AIH I型患者GLO为(35.2±9.8)g/L显著高于AIH II型患儿的(24.1±6.7)g/L;AIH I型患儿IgG为(27.4±5.2)g/L高于AIH II型患儿的(19.7±4.4)g/L,差异有统计学意义(P<0.05);两种分型患儿ALT、AST及TBil均差异无统计学意义(P>0.05)。患儿肝脏组织学中界面性肝炎12例,浆细胞或淋巴细胞浸润18例,肝纤维化22例,玫瑰花结6例,胆管病变3例,AIH I型、AIH II型及未分型患儿肝脏组织学差异无统计学意义(P>0.05)。治疗有效21例,难治6例,复发11例,AIH I型、AIH II型及未分型患者治疗有效、难治及复发例数差异无统计学意义(P>0.05)。结论AIH I型、II型及未分型患儿临床表现多样,实验室指标、肝脏组织学结果较为严重,泼尼松+硫唑嘌呤可以有效改善病情,但治疗后易复发,需坚持治疗。

Objective Clinical characteristics and therapeutic effect of children with autoimmune hepatitis(AIH).Methods A total of 22 children(6 males and 14 females)with AIH admitted to our department from June 2014 to June2019 were selected with an average age of(9.5±4.4)years.The treatment was prednisone 2 mg/kg/d(maximum dose 60 mg/d)1 month after azathioprine treatment 2 mg/kg/d(maximum100 mg/d).After 3 months of treatment,the hormone drug dose was gradually reduced until it stopped.The measurement data were expressed as(x±s)or[M(P25,P75)],ttest or Kruskal-Wallis H test;the counting data were expressed as absolute numbers and compared by chi-square test.Results Among the 22 cases of AIH,6 cases were acute course,10 cases were subacute course and 6 cases were chronic course.13 cases were AIH type Ⅰ,5 cases were AIH type Ⅱ,4 cases were unclassified.There was no significant difference among the three groups(P>0.05).GLO in patients with AIH type Ⅰ[(35.2±9.8)g]was significantly higher than that in patients with AIH type Ⅱ[(24.1±6.7)g,P<0.05].The IgG of patients with AIH type Ⅰ[(27.4±5.2)g]was significantly higher than that of patients with AIH type Ⅱ[(19.7±4.4 g)g,P<0.05],but there was no significant difference in ALT,AST and TBIL between the two types(P>0.05).The results of liver histology included interfacial hepatitis(n= 12),plasma cell or lymphocyte infiltration(n= 18),hepatic fibrosis(n= 22),rosette(n= 6)and bile duct lesion(n= 3).There was no significant difference in liver histological results among AIH Ⅰ,AIH Ⅱ and unclassified patients(P>0.05).All patients were followed up after treatment,21 cases were effective,6 cases were refractory and 11 cases were recurrent.there was no significant difference in the number of effective,refractory and recurrent cases between AIH type Ⅰ,AIH type Ⅱ and unclassified patients(P>0.05).Conclusion The clinical manifestations of AIH type Ⅰ,Ⅱ and unclassified children are various,and the laboratory indexes and liver histological results are more serious.Prednisone+ azathioprine can effectively improve the condition of AIH patients,but the patients are prone to recurrence after treatment and need to adhere to the treatment.