自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征湿热瘀阻证与湿热中阻证的临床病理特征分析

Analysis of Clinicopathological Features of Damp Heat and Blood Stasis Syndrome and Damp Heat Moderate Obstruction Syndrome in AIH-PBC Overlap Syndrome

目的:探讨自身免疫性肝炎(AIH)-原发性胆汁性胆管炎(PBC)重叠综合征湿热瘀阻证与湿热中阻证患者临床病理特征的差异。方法:比较两种证型患者在肝组织病理、人口学特征、肝功能、免疫球蛋白、自身免疫抗体检测等方面的差异,通过多因素回归分析其与证型的相关性。结果:67例湿热中阻证患者病情较轻,湿热瘀阻证为AIH-PBC重叠综合征最常见类型,湿热瘀阻证患者谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)均较湿热中阻证患者明显升高,差异有统计学意义(P<0.001);湿热瘀阻证组出现玫瑰花环、胆管缺失和假小叶的病理表现明显多于湿热中阻证,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,患者的GGT水平、纤维化分期3~4期、胆管缺失等病理特征与湿热中阻证相比,更倾向于湿热瘀阻证。结论:AIH-PBC重叠综合征湿热中阻证、湿热瘀阻证患者在肝硬化发生率、部分血生化指标、肝组织病理特征等方面存在差异,患者的GGT及部分肝组织病理特征有助于证型的判断。

Objective:To investigate the differences of clinicopathological features between patients with damp heat and blood stasis syndrome and patients with damp heat moderate obstruction syndrome in autoimmune hepatitis(AIH)-primary biliary cholangitis(PBC)overlap syndrome.Methods:The liver histopathology,demographic characteristics,liver function,immunoglobulin and autoimmune antibody detection were compared between the two syndrome types,and multivariate regression analysis was used to find its correlation with syndrome types.Results:The 67 patients with damp heat moderate obstruction syndrome were relatively mild,and damp heat and blood stasis syndrome was the most common type of AIH-PBC overlap syndrome.The levels of glutamyltranspeptidase(GGT)and alkaline phosphatase(AKP)in patients with damp heat and blood stasis syndrome were significantly higher than those in patients with damp heat moderate obstruction syndrome(P<0.001);the pathological manifestations of rosette,absence of bile duct and pseudolobule in damp heat and blood stasis group were significantly more than those in damp heat moderate obstruction syndrome,and the difference was statistically significant(P<0.05).The results of logistic regression analysis showed that the pathological characteristics of patients,such as GGT level,fibrosis stage 3-4 and bile duct loss,were more inclined to damp heat and blood stasis syndrome than damp heat moderate obstruction syndrome.Conclusion:There is difference in the incidence of liver cirrhosis,some blood biochemical indexes and pathological characteristics of liver tissue in AIH-PBC overlap syndrome patients between damp heat moderate obstruction syndrome and damp heat and blood stasis syndrome.GGT and some pathological characteristics of liver tissue are helpful to judge the syndrome type.