| 郭银燕,钟艳丹,俞海英,等.自身免疫性肝病的临床和病理特征分析[J].安徽医药,2023,27(5):976-980. |
| 自身免疫性肝病的临床和病理特征分析 |
| Clinical and pathological features of patients with autoimmune liver disease |
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| DOI：10.3969/j.issn.1009-6469.2023.05.028 |
| 中文关键词: 肝炎，自身免疫性 胆管炎 硬化性 病理学 疾病特征 |
| 英文关键词: Hepatitis,autoimmune Cholangitis Sclerosing Pathology Disease feature |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| 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 diag-nosed with AILD (except one case of primary sclerosing cholangitis) from July 2018 to September 2020 were recruited, including 37cases of autoimmune hepatitis (AIH group), 43 cases of primary biliary cirrhosis (PBC group) and 20 cases of AIH-PBC overlap syn-drome (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 immuno-globulin A (IgA)] among three groups (P>0.05). Compared with PBC group, the levels of alamine aminotransferase (ALT) and aspartateaminotransferase (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), anti-multiple nuclear dots (SP100) and smooth muscle actin antibody (SMA) among the three groups (All P <0.05). Among 53 patients whounderwent liver biopsy pathological examination, there were 29 cases of AIH, 11 cases of PBC, and 13 cases of OS. In addition, thestages 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. |
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