摘要
目的探讨自身免疫性肝炎(AIH)患者的临床表现、生化、免疫学及组织学特征,为该病的诊断及鉴别诊断提供依据。方法回顾性分析和研究50例AHI患者的临床特点、生化指标、免疫学检查和肝脏组织学特征。结果50例AIH患者男女比例为1︰11.5,发病年龄为52.3±13.8岁。发病至确诊的中位时间为12个月。临床表现以乏力(72.0%)、黄疸(56.0%)、纳差(50.0%)为主。生化检查结果示高转氨酶血症、高球蛋白血症及自身抗体阳性(抗核抗体90%,抗平滑肌抗体18%,抗肝肾微粒体抗体6%,抗可溶性肝抗原/肝-胰抗体8%,周围型抗中性粒细胞胞浆抗体32.0%)。22例接受肝穿刺的AIH患者肝组织学均呈活动性慢性炎症表现,其中界面炎/碎屑坏死100%,浆细胞浸润63.6%,明显的小叶内炎症54.5%,桥接坏死54.5%,小叶内融合性坏死45.5%,玫瑰花结样结构45.5%,假小叶形成31.8%。共32例患者接受规律免疫抑制治疗,其中24例(75.00%)达到完全应答,3例(9.38%)达到部分缓解,6例(18.75%)出现复发。结论 AIH患者多见于女性,临床表现缺乏特异性,容易误诊,需综合生化、免疫学及组织病理学特点做出诊断。该病对糖皮质激素应答良好,早期诊断制定合适的治疗方案意义重大。
Objective To analyze the clinical,biochemical,immunological and pathological features of autoimmune hepatitis（ AIH）.Methods According to the revised criteria for diagnosis of autoimmune hepatitis proposed by the International Autoimmune Hepatitis Group（ IAIHG）,50 cases of patients with AIH were selected into this study. Their clinical,biochemical,immunological and pathological characteristics were retrospectively analyzed. Results AIH occurred mainly in female and the ratio of male to female was 1： 11. 5. Average age was 52. 3 ± 13. 8.The most common symptoms were fatigue（ 72. 0%）,jaundice（ 56. 0%） and loss of appetite（ 50. 0%）. There were raised levels of serum aminotransferase,hyper- gamma- globulinemia and positive of circulating autoantibodies. Histological features of 22 AIH liver showed the lesions of chronic active hepatitis such as interface hepatitis / piecemeal necrosis（ 100%）,predominant plasmacytic infiltration（ 63. 6%）,obvious lobular inflammation（ 54. 5%）,bridging necrosis（ 54. 5%）,confluent necrosis in lobular central areas（ 45. 5）,rosetting of liver cells（ 45. 5%） and formation of pseudo lobule（ 31. 8%）. 32 patients received glucocorticoid treatment. The complete biochemical remission rate was 75. 00%. Conclusion AIH occurred mainly in mid- aged female. There are no specificity of clinical manifestations,laboratory findings,and histological features. Early diagnosis and treatment can improve the prognosis.
出处
《临床和实验医学杂志》
2015年第13期1093-1096,共4页
Journal of Clinical and Experimental Medicine
关键词
自身免疫性肝炎
临床特征
病理学
Autoimmune hepatitis
Clinical characteristics
Pathology
