以急性、慢性肝损伤模式起病的自身免疫性肝炎患者临床特点及治疗效果比较

Comparison of clinical characteristics and therapeutic effects in autoimmune hepatitis patients presenting with acute and chronic liver injury patterns

目的比较分析以急性、慢性肝损伤模式起病的自身免疫性肝炎(AIH)患者临床特征,并观察临床治疗方案的效果差异。方法选取2020年1月—2022年1月信阳市中心医院收治的AIH患者98例,按照临床诊断分为急性起病组(n=46)和慢性起病组(n=52),分析两组临床资料,给予糖皮质激素治疗后对比两组的疗效。结果经分析,急性起病组和慢性起病组的首发症状中,黄疸在急性起病组中更常见,占比21.7%,高于慢性起病组的7.7%(P<0.05);而慢性起病组首发无症状者占比28.8%,高于急性起病组10.9%(P<0.05);炎症表现中,急性起病组中肝小叶炎症占比为56.5%,高于慢性起病组的34.6%(P<0.05),而门静脉炎占比仅为17.4%,低于慢性起病组55.8%(P<0.05);慢性起病组纤维化比例为82.7%,相对于急性起病组65.2%更高(P<0.05);生化指标上看,慢性起病组AST值为(169.9±10.4)U/L,低于急性起病组[(206.5±13.5)U/L,P<0.05],慢性起病组ALT水平为(196.7±11.4)U/L,低于急性起病组[(279.8±14.7)U/L,P<0.05],慢性起病组IgG水平为(1807.8±122.7),较急性起病组更高[(1648.8±110.9),P<0.05]。治疗6个月后,急性起病组ALT水平(20.1±2.0)U/L,低于慢性起病组[(24.7±1.9)U/L,P<0.05],IgG水平为(941.5±90.1),低于慢性起病组[(1122.7±100.2),P<0.05]。急性起病组的总有效率为95.7%,较慢性起病组的82.7%更高(P<0.05)。结论不同的炎症导致的起病急缓不同,而起病急缓的首发症状和生化指标也存在一定差异,急性起病的患者应用标准治疗方案的疗效较慢性起病更显著,在临床治疗中需根据炎症类型和患者对治疗方案的适应性进行及时的用药调整。

Objective To compare the clinical features of patients with autoimmune hepatitis(AIH)presenting with acute versus chronic liver injury,and to evaluate the differences in clinical treatment strategies.Methods Ninety-eight patients with AIH admitted to our hospital betwee January 2020 and January 2022 were selected and divided into two groups based on clinical diagnosis:the acute onset group(n=46)and the chronic onset group(n=52).The clinical data of both groups were analyzed,and the efficacy of glucocorticoid treatment was compared between the two groups.Results Upon analysis,jaundice was more commonly observed as an initial symptom in the acute onset group(21.7%)compared to the chronic onset group(7.7%)(P<0.05).Conversely,the percentage of initially asymptomatic patients was higher in the chronic onset group(28.8%)than in the acute onset group(10.9%)(P<0.05).Regarding inflammatory manifestations,hepatic lobular inflammation was more prevalent in the acute onset group(56.5%)than in the chronic onset group(34.6%)(P<0.05),while portal phlebitis was less common in the acute onset group(17.4%)compared to the chronic onset group(55.8%)(P<0.05).The incidence of fibrosis was higher in the chronic onset group(82.7%)than in the acute onset group(65.2%)(P<0.05).Biochemically,the AST level in the chronic onset group was(169.9±10.4)U/L,lower than in the acute onset group[(206.5±13.5)U/L,P<0.05],the ALT level in the chronic onset group was(196.7±11.4)U/L,also lower than in the acute onset group[(279.8±14.7)U/L,P<0.05].The IgG level in the chronic onset group was(1807.8±122.7)mg/dl,higher than in the acute onset group[(1648.8±110.9)U/L,P<0.05].After 6 months of treatment,the ALT level in the acute onset group was(20.1±2.0)U/L,lower than in the chronic onset group[(24.7±1.9)U/L,P<0.05],and the IgG level was(941.5±90.1)mg/dl,lower than in the chronic onset group[(1122.7±100.2)mg/dl,P<0.05].Conclusion Different inflammatory conditions lead to varing degrees of urgency in onset,resulting in differences in initial symptoms and biochemical indicators.Patients with acute onset respond more significantly to standard treatment regimens compared to those with chronic onset.Therefore,timely adjustments to medication are necessary in clinical treatment,taking into account the type of inflammation and the patient’s suitability for the treatment regimen.