摘要
目的提高对自身免疫性肝病的认识,以利于早期诊断、早期治疗。方法回顾性对81例自身免疫性肝病患者进行诊断,比较自身免疫性肝炎(AIH)、原发性胆汁性肝硬化(PBC)及其重叠综合征(OS)的临床、血液化学及病理特点。结果81例患者中,女性占91.4%;总体误诊率为45.7%,OS漏诊率为96.7%,初始诊断为肝硬化者60.5%(49/81),其中37%(30/81)为失代偿期肝硬化。AIH组18.2%(6/33)以急性肝功能衰竭发病,明显高于PBC、OS组,3组患者症状、体征基本一致,AIH、OS组患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平及抗核抗体(ANA)阳性率明显高于PBC组(Z=6.411,P=0.041;Z=7.980,P=0.019;χ2=11.951,P=0.003),PBC、OS组患者血清门冬氨酸氨基转移酶(GGT)、碱性磷酸酶(ALP)、总胆固醇、载脂蛋白B水平及抗线粒体抗体(AMA)阳性率明显高于AIH组(Z=37.327,P=0.000;Z=12.929,P=0.002;Z=16.722,P=0.000;Z=6.695,P=0.035;χ2=31.219,P=0.000)。结论自身免疫性肝病误诊率高。AIH、OS患者氨基转移酶升高明显,ANA阳性率高,PBC、OS患者GGT、ALP升高明显,血脂代谢障碍,AMA阳性率高。
Objective To raise awareness on autoimmune liver diseases,in order to lead to early diagnosis and treatment of the diseases.Methods Eighty one patients with autoimmune liver diseases were collected,and rediagnosed with current criteria.The clinical,biological,and histological features of patients in autoimmune hepatitis（AIH）,primary biliary cirrhosis（PBC） and overlap syndrome（OS） group were compared.Results Of 81 patients,female accounted for 91.4%.The misdiagnosis rate was 45.7%.The rate of missed diagnosis of patients with OS was 96.7%,and 49 cases（4981） were diagnosed as liver cirrhosis first,among which 37%（3081） patients had been decompensated liver cirrhosis.18.2%（633）of patients with AIH were onset of acute hepatic failure,which was significantly higher than that of patients with PBC and OS.The symptoms and signs of patients in the three groups were similar.Serum alanine aminotransferase（ALT）,aspartate aminotransferase（AST） levels and positive rate of antinuclear antibody（ANA） of patients with AIH and OS were significantly higher than those of patients with PBC（Z=6.411,P=0.041, Z=7.980,P=0.019, χ2=11.951,P=0.003）, Serum alkaline phosphatase（ALP）,gamma-glutamyl transpeptidase（GGT）,cholesterol,apoprotein B levels and positive rate of antimitochondrial antibody（AMA） in PBC and OS patients were significantly higher than those in AIH patients（Z=37.327,P=0.000, Z=12.929,P=0.002, Z=16.722,P=0.000, Z=6.695,P=0.035, χ2=31.219,P=0.000）.Conclusions Misdiagnosis rate of autoimmune liver diseases is high.Serum transaminase level and positive rate of ANA are higher in patients with AIH and OS,and patients with OS and PBC have higher serum levels of ALP,GGT and positive rate of AMA,and they have disturbance of blood lipoidosis metabolism.
出处
《国际内科学杂志》
CAS
2008年第9期501-504,共4页
International Journal of Internal Medicine
基金
广东省科技攻关项目资助(2007B060401001)
