摘要
目的比较自身免疫性肝炎(AIH)合并原发性胆汁性胆管炎(PBC)或部分肝外自身免疫性疾病(autoimmune disease)患者与单纯AIH患者临床特点及并发症,为改善AIH患者的诊治提供参考。方法收集1999年8月~2019年8月我院收治的AIH患者149例,根据合并症分为无合并病的AIH组(68例)、AIH合并PBC组(AIH-PBC组,41例)及AIH合并肝外自身免疫性疾病组(AIH-肝外组,40例),比较三组临床特点、并发症、肝纤维化/肝硬化进展情况。结果①AIH-PBC组及AIH-肝外组年龄低于AIH组,差异有统计学意义(P<0.05);三组性别比较,差异无统计学意义(P>0.05)。②三组共有的临床症状为瘙痒、黄疸、乏力、食欲不振及腹部不适,其中AIH-PBC组瘙痒症状患者多于AIH组、AIH-肝外组,差异有统计学意义(P<0.05);三组黄疸、乏力、食欲不振及腹部不适比较,差异无统计学意义(P>0.05)。③AIH-PBC组ALT低于AIH组及AIH-肝外组,ALP、GGT高于AIH组及AIH-肝外组,差异有统计学意义(P<0.05);AIH-肝外组的AST、DBIL高于AIH组及AIH-PBC组,差异有统计学意义(P<0.05);AIH-肝外组IgG水平高于AIH组及AIH-PBC组,差异有统计学意义(P<0.05)。④三组ANA、ASMA、SLA、LKM-1阳性率比较,差异无统计学意义(P>0.05);AIH-PBC组AMA、AMA-M2阳性率高于AIH组、AIH-肝外组,差异有统计学意义(P<0.05)。⑤三组均以界面性肝炎和淋巴细胞浸润表现居多,其中AIH-PBC组胆管病变、胆汁淤积高于AIH组,差异有统计学意义(P<0.05)。⑥三组并发症主要包括食管胃底静脉曲张/破裂出血、腹水、肝性脑病、肝癌、肝移植,组间比较,差异无统计学意义(P>0.05)。⑦三组肝纤维化/肝硬化发生率比较,差异无统计学意义(P>0.05);但AIH-PBC组2~5年肝纤维化/肝硬化进展率高于AIH组及AIH-肝外组,差异有统计学意义(P<0.05)。结论合并PBC的AIH患者比单纯AIH患者诊断年龄早,肝脏炎症反应轻、胆管病变重;比AIH及合并肝外自身免疫性疾病�
Objective To compare the clinical characteristics and complications of patients with autoimmune hepatitis(AIH)with primary biliary cholangitis(PBC)or some extrahepatic autoimmune disease and patients with AIH alone,to provide a reference for improving the diagnosis and treatment of patients with AIH.Methods A total of 149 AIH patients admitted in our hospital from August 1999 to August 2019 were collected and divided into AIH group without complications(68 cases),AIH combined with PBC group(AIH-PBC group,41 cases),and AIH according to comorbidities.The extrahepatic autoimmune disease group(AIH-extrahepatic group,40 cases)was combined,and the clinical characteristics,complications,and liver fibrosis/cirrhosis progress were compared among the three groups.Results①The age of AIH-PBC group and AIH-extrahepatic group was lower than AIH group,the difference was statistically significant(P<0.05);there was no statistically significant difference between the three groups(P>0.05).②The clinical symptoms common to the three groups were pruritus,jaundice,fatigue,loss of appetite,and abdominal discomfort.Among the patients in the AIH-PBC group,there were more pruritus symptoms than in the AIH and AIH-extrahepatic groups,the difference was statistically significant(P<0.05);There was no significant difference in jaundice,fatigue,loss of appetite and abdominal discomfort among the three groups(P>0.05).③AIH-PBC group had lower ALT than AIH group and AIH-extrahepatic group,ALP and GGT were higher than AIH group and AIH-extrahepatic group,the difference was statistically significant(P<0.05);AST and DBIL of AIH-extrahepatic group compared with AIH group and AIH-PBC group,the difference was statistically significant(P<0.05);AIH-extrahepatic group IgG levels were higher than AIH group and AIH-PBC group,the difference was statistically significant(P<0.05).④There was no significant difference in the positive rates of ANA,ASMA,SLA,and LKM-1 in the three groups(P>0.05).The positive rates of AMA and AMA-M2 in the AIH-PBC group were
作者
张小雨
严艳
ZHANG Xiao-yu;YAN Yan(Department of Gastroenterology,Subject One,the Second Affiliated Hospital of Dalian Medical University,Dalian 116000,Liaoning,China)
出处
《医学信息》
2020年第2期89-93,共5页
Journal of Medical Information
