急性自身免疫性肝炎的临床和病理特征

摘要/Abstract

摘要： 目的分析急性起病自身免疫性肝炎(AIH)患者临床和病理特征。方法选取2010年5月至2020年11月经肝穿刺活检的AIH患者74例,年龄(53.4±11.3)岁,其中急性起病AIH 28例(急性组),诊断需至少符合以下一项:总胆红素(TBil)≥85.5 μmol/L,ALT(AST)≥10×正常值上限;非急性起病46例(非急性组)。(±s)或[M(P₂₅,P₇₅)]表示计量资料,t检验或Kruskal-Wallis H 检验比较;(%)表示计数资料,卡方检验比较。结果急性组、非急性组AIH患者TBIL、ALT、AST、PT、INR、IgG、抗核抗体(ANA)、肝纤维化程度等差异具有统计学意义(P<0.05),而两组患者年龄、性别、WBC、PLT、抗平滑肌抗体(ASMA)、抗肝可溶性抗原抗体(抗-SLA)、抗肝肾微粒体抗体(抗-LKM)、抗中性粒细胞浆抗体(ANCA)及肝炎炎症活动度等差异不具有统计学意义(P>0.05)。急性组、非急性组AIH患者黄疸、厌食、尿黄及厌油等差异具有统计学意义(P<0.05),而两组患者疲乏、腹水、腹痛、体重下降、下肢浮肿及关节疼痛等差异不具有统计学意义(P>0.05)。结论临床实践中以急性起病的AIH病例数量并不少见,而仅凭IAIHG评分难以甄别出这部分患者。相较于非急性AIH,急性患者肝脏转氨酶、凝血指标及肝纤维化程度均存在显著差异,这些指标将有助于区分二者。在临床表现中,急性起病AIH以黄疸、厌食、尿黄及厌油等较为多见,这将有助于临床医师早期发现。

关键词: 自身免疫性肝炎, 抗核抗体, 肝纤维化

Abstract: Objective Analysis of clinical and pathological features of autoimmune hepatitis (AIH) patients of acute onset.Methods A total of 74 patients with AIH, aged (53.4 ± 11.3) years, were selected between May 2010 and November 2010. Among them, 28 patients with AIH of acute onset (acute group), the diagnosis should be in accordance with at least one of the following items: total bilirubin (TBil) ≥ 85.5 μmol/L, ALT (AST) ≥ 10 × normal limit, and 46 cases of non-acute onset (non-acute group). (±s) or [M(P₂₅, P₇₅)] represented measurement data, t-test or Kruskal-Wallis H test were used; (%) represented counting data, chi-square test were used.Results There were significant differences in TBil, ALT, AST, PT, INR, IgG, antinuclear antibody (ANA) and the degree of liver fibrosis between acute group and non-acute group of AIH (P<0.05). There was no significant difference in age, sex, WBC, PLT, anti-smooth muscle antibody (ASMA), anti-liver soluble antigen antibody (anti-SLA), anti-liver and kidney microsomal antibody (anti-LKM), anti-neutrophil cytoplasmic antibody (ANCA) and hepatitis inflammatory activity between the two groups (P>0.05). There were significant differences in jaundice, anorexia, yellow urine and oil weariness between acute group and non-acute group in AIH patients (P<0.05), but there was no significant difference in fatigue, ascites, abdominal pain, weight loss, lower limb edema and joint pain between the two groups (P>0.05).Conclusion In clinical practice, the number of AIH cases of acute onset is not uncommon, and it is difficult to identify these patients only through IAIHG score. Compared with non-acute AIH, there are significant differences in liver transaminase, coagulation index and degree of liver fibrosis in acute patients, which will help to distinguish them. In the clinical manifestations, jaundice, anorexia, yellow urine and oil-weariness are more significant in AIH of acute onset, which will help clinicians to find out in the early stage.

Key words: Autoimmune hepatitis, Antinuclear antibody, Liver fibrosis

聂虹, 宋洁, 时牛. 急性自身免疫性肝炎的临床和病理特征[J]. 肝脏, 2021, 26(6): 664-666.

NIE Hong, SONG Jie, SHI Niu. Clinical and pathological features of acute autoimmune hepatitis[J]. Chinese Hepatolgy, 2021, 26(6): 664-666.

参考文献

[1] Li X, Xu H, Gao P. Red blood cell distribution width-to-platelet ratio and other laboratory indices associated with severity of histological hepatic fibrosis in patients with autoimmune hepatitis: a retrospective study at a single center. Med Sci Monit, 2020, 26:e927946.
[2] Lam S, Singh R, Dillman JR, et al. Serum matrix metalloproteinase 7 is a diagnostic biomarker of biliary injury and fibrosis in pediatric autoimmune liver disease. Hepatol Commun, 2020, 4:1680-1693.
[3] Mesropyan N, Kupczyk P, Dold L, et al. Non-invasive assessment of liver fibrosis in autoimmune hepatitis: diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction. Abdom Radiol (NY), 2020.
[4] Thomsen H, Li X, Sundquist K, et al. Familial associations between autoimmune hepatitis and primary biliary cholangitis and other autoimmune diseases. PLoS One, 2020, 15:e0240794.
[5] Fujiwara K, Nakano M, Yasui S, et al. Advanced histology and impaired liver regeneration are associated with disease severity in acute-onset autoimmune hepatitis. Histopathology, 2011, 58:693-704.
[6] Onji M. Autoimmune Hepatitis Study Group. Proposal of autoimmune hepatitis presenting with acute hepatitis, severe hepatitis and acute liver failure. Hepatol Res, 2011, 41:497.
[7] Dohmen K, Tanaka H, Haruno M, et al. Immunoserological and histological differences between autoimmune hepatitis with acute presentation and chronic autoimmune hepatitis.?Hepatol Res, 2017, 47:1375-1382.
[8] Kogan J, Safadi R, Ashur Y, et al. Prognosis of symptomatic versus asymptomatic autoimmune hepatitis: a study of 68 patients. J Clin Gastroenterol, 2002, 35:75-81.
[9] Chinese Society of Hepatology, Chinese Society of Gastroenterology & Chinese Society of Infectious Diseases. Chinese consensus on the diagnosis and management of autoimmune hepatitis (2015). J Dig Dis, 2017, 18:247-264.
[10] Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol,1999, 31:929-938.
[11] Yeoman AD, Westbrook RH, Al-Chalabi T, et al. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease. Hepatology, 2009, 50:538-545.
[12] Yeoman AD, Westbrook RH, Zen Y, et al. Prognosis of acute severe autoimmune hepatitis (AS-AIH): the role of corticosteroids in modifying outcome. J Hepatol, 2014, 61:876-882.
[13] Nguyen Canh H, Harada K, Ouchi H, et al. Acute presentation of autoimmune hepatitis: a multicentre study with detailed histological evaluation in a large cohort of patients. J Clin Pathol, 2017, 70:961-969.
[14] Fujiwara K, Fukuda Y, Yokosuka O. Precise histological evaluation of liver biopsy specimen is indispensable for diagnosis and treatment of acute-onset autoimmune hepatitis. J Gastroenterol, 2008, 43:951-958.
[15] Omagari K, Masuda J, Kato Y, et al. Re-analysis of clinical features of 89 patients with autoimmune hepatitis using the revised scoring system proposed by the International Autoimmune Hepatitis Group. Intern Med, 2000, 39:1008-1012.