摘要
目的 探讨自身免疫性肝病(AILD)病人生化免疫指标、临床和肝组织病理特征。方法 选取2018年7月至2020年9月于南京市第二医院肝病免疫科诊断的AILD病人100例(1例原发性硬化性胆管炎除外),其中自身免疫性肝炎(AIH组)37例、原发性胆汁性肝硬化(PBC组)43例、AIH-PBC重叠综合征(OS组)20例,分析三组病人特征。结果 三组性别、年龄、总胆红素(TBIL)、γ-谷氨酰转肽酶(γ-GT)和免疫学指标[免疫球蛋白G(IgG)和免疫球蛋白A(IgA)]比较,差异无统计学意义(P>0.05)。AIH组与PBC组相比,AIH组血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)异常升高,而PBC组血清碱性磷酸酶(ALP)和免疫球蛋白M(IgM)异常升高(P<0.05)。三组抗核抗体(ANA)、抗线粒体抗体(AMA)、AMA-M2、核包膜蛋白抗体(GP210)、核多点抗体(SP100)和平滑肌肌动蛋白抗体(SMA)阳性检出率比较,均差异有统计学意义(P<0.05)。53例行肝穿刺病理检查的病人中,AIH 29例,PBC 11例和OS 13例;AIH组以G2~3和S1~3为主;PBC组以G1~2和S1~2为主;OS组以G2~3、S1和S3为主,其表现更倾向AIH。结论 鉴于AILD中OS病人临床和病理特征表现出AIH和PBC双重特点,临床应重视AILD相关抗体的检测,以提高该疾病的早期诊断和分型鉴别能力。
Objective To explore the biochemical immune indexes,clinical and pathological features of patients with autoimmune liver disease(AILD).Methods In Department of Hepatology and Immunology of Nanjing Second Hospital,a total of 100 patients diagnosed with AILD(except one case of primary sclerosing cholangitis)from July 2018 to September 2020 were recruited,including 37 cases of autoimmune hepatitis(AIH group),43 cases of primary biliary cirrhosis(PBC group)and 20 cases of AIH-PBC overlap syndrome(OS group).The characteristics of patients were analyzed among three groups.Results There were no significant differences in gender,age,total bilirubin(TBIL),γ-glutamyl transpeptidase(γ-GT)and immunological indexes[immunoglobulin G(IgG)and immunoglobulin A(IgA)]among three groups(P>0.05).Compared with PBC group,the levels of alamine aminotransferase(ALT)and aspartate aminotransferase(AST)increased abnormally in AIH group,while the levels of alkaline phosphatase(ALP)and immunoglobulin M(IgM)in PBC group were markedly increased compared with AIH group(P<0.05).There were significant differences in the positive rates of antinuclear antibodies(ANA),anti-mitochondrial antibody(AMA),AMA-M2,nuclear pore glycoprotein antibody(GP210),antimultiple nuclear dots(SP100)and smooth muscle actin antibody(SMA)among the three groups(All P<0.05).Among 53 patients who underwent liver biopsy pathological examination,there were 29 cases of AIH,11 cases of PBC,and 13 cases of OS.In addition,the stages of liver inflammation and fibrosis of patients were mainly at G2-3 and S1-3 in AIH group,at G1-2 and S1-2 in PBC group,and at G2-3,S1 and S3 in OS group,which were more prone to AIH.Conclusion Clinical and pathological features of patients with OS show dual characteristics of AIH and PBC,thus the detection of AILD-related antibodies should be emphasized to improve the ability of early diagnosis and typing differentiation of AILD.
作者
郭银燕
钟艳丹
俞海英
丁巧云
彭姗姗
曹兴国
GUO Yinyan;ZHONG Yandan;YU Haiying;DING Qiaoyun;PENG Shanshan;CAO Xingguo(Department of Hepatology,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing Second Hospital,Nanjing,Jiangsu 210003,China)
出处
《安徽医药》
CAS
2023年第5期976-980,共5页
Anhui Medical and Pharmaceutical Journal
