摘要
目的分析临床变量和肝组织学变化对自身免疫性肝炎肝纤维化和肝硬化发展的预后价值。方法2019年8月至2020年8月河池市人民医院收治的自身免疫性肝炎患者65例,其中肝纤维化组35例,肝硬化组30例。比较两组临床变量和肝组织学变化、激素治疗预后分析,运用多因素logistic回归分析自身免疫性肝炎肝纤维化和肝硬化发展的独立危险因素。结果肝纤维化组病程为(70.3±4.2)d,高于肝硬化组的(54.6±5.8)d(P<0.05)。肝纤维化组血清总胆红素、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、白蛋白、球蛋白、IgG水平分别为(313.2±102.3)μmol/L、(353.5±65.4)U/L、(322.6±157.8)U/L、(27.2±4.5)g/L、(35.6±8.5)g/L、(28.6±8.3),低于肝硬化组的(412.5±101.6)μmol/L、(463.5±48.6)U/L、(420.5±156.3)U/L、(35.8±5.6)g/L、(43.6±8.6)g/L、(38.8±10.5)(P<0.05)。肝纤维化组白细胞计数为(2.6±1.5)×10^(9)/L,高于肝硬化组(1.7±0.8)×10^(9)/L(P<0.05);肝纤维化组国际标准化比值为1.7±0.2,优于肝硬化组1.9±0.3(P<0.05);肝纤维化组终末期肝病模型评分为(22.1±2.6)分,优于肝硬化组(26.9±1.8)分(P<0.05);肝纤维化组汇管区淋巴细胞浸润占比为5.7%,少于肝硬化组的33.3%(P<0.05)。生存组病程、总胆红素水平、终末期肝病模型评分以及白细胞计数分别为(60.3±4.2)d、(243.2±92.3)μmol/L、(12.1±2.6)分、(2.1±1.8)×10^(9)/L,明显低于死亡组(94.6±5.8)d、(412.5±121.6)μmol/L、(25.9±1.8)分、(4.6±1.5)×10^(9)/L(P<0.05)。多因素logistic回归分析结果显示,病程、总胆红素、终末期肝病模型评分、白细胞计数是自身免疫性肝炎肝纤维化和肝硬化发展的独立危险因素(OR=4.646、4.968、5.078、4.933,P<0.05)。结论自身免疫性肝炎起病急,症状不典型且病情发展快速,病死率较高,肝纤维化和肝硬化患者的预后与病程、总胆红素、终末期肝病模型评分、白细胞计数有关。
Objective To evaluate the prognostic significance of clinical variables and hepatic histopathological changes in predicting the progression to liver fibrosis and cirrhosis in patients with autoimmune hepatitis(AIH).Methods Between August 2019 and August 2020,sixty-five patients with autoimmune hepatitis(AIH)were admitted to our hospital,and their clinical data were systematically collected.These patients were categorized into two groups based on the progression of their disease:a liver fibrosis group(n=35)and a cirrhosis group(n=30).Comparative analyses of clinical variables and hepatic histological changes were conducted between these groups.Additionally,prognostic analysis of hormonal therapy and independent risk factors contributing to the development of hepatic fibrosis and cirrhosis in AIH patients were analyzed by multifactorial Logistic regression.Results In the liver fibrosis group of AIH patients,the mean duration of disease onset was(70.3±4.2)d,significantly longer than the(54.6±5.8)d,observed in the cirrhosis group(P<0.05).Notably,serum levels of total bilirubin,glutathione,glutathione,albumin,globulin,and IgG in the liver fibrosis group were(313.2±102.3)μmol/L,(353.5±65.4)U/L,(322.6±157.8)U/L,(27.2±4.5)g/L,(35.6±8.5)g/L,(28.6±8.3),respectively,which were markedly lower compared to the cirrhotic group[(412.5±101.6)μmol/L,(463.5±48.6)U/L,(420.5±156.3)U/L,(35.8±5.6)g/L,(43.6±8.6)g/L,(38.8±10.5),respectively,P<0.05].The international normalized ratio was(1.7±0.2)points in the fibrosis group,which was more favorable than the(1.9±0.3)points in the cirrhosis group(P<0.05).The model for end-stage liver disease(MELD)socre was lower in the liver fibrosis group(22.1±2.6)compared to the cirrhosis group[(26.9±1.8),P<0.05].Additionally,lymphocytic infiltration in confluent areas was less in the liver fibrosis group(5.7%)compared to 33.3%in the cirrhosis group(P<0.05).In terms of prognosis,the survival group showed significantly lower morbidity duration,total bilirubin levels,MELD score,and white blood cell count[(60.3±4.2)d,(243.2±92.3)μmol/L,(12.1±2.6)points,and(2.1±1.8)×10^(9)/L,respectively]compared to the death group[94.6±5.8)d,(412.5±121.6)μmol/L,(25.9±1.8)points,and(4.6±1.5)×10^(9)/L,respectively,P<0.05];Multifactorial Logistic regression analysis identified duration of morbidity,elevated bilirubin,MELD score,and white blood cell count as independent risk factors for the development of liver fibrosis and cirrhosis in AIH(OR=4.646,4.968,5.078,4.933,P<0.05).Conclusion The prognosis of patients with liver fibrosis and cirrhosis in AIH is closely associated with several key factors:the duration of the disease,total bilirubin levels,MELD score,and white blood cell count.
作者
杨月华
蓝婧
姚朝光
黄佳
YANG Yue-hua;LAN Jing;Yao Chao-guang;Huang Jia(Department of Gastroenterology,The People’s Hospital of Hechi(Hechi Hospital,the First affiliated Hospital of Guangxi Medical University),Guangxi 547000,China)
出处
《肝脏》
2023年第12期1487-1491,共5页
Chinese Hepatology
基金
广西科学研究与技术开发计划项目(14124004-1-24)。
关键词
肝组织学变化
自身免疫性肝炎
肝纤维化
肝硬化
预后
Hepatic histological changes
Autoimmune hepatitis
Liver fibrosis
cirrhosis
Prognosis
