中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2014年
2期
105-108
,共4页
王丕胜%王吉耀%胡锡琪%晋继红%李锋
王丕勝%王吉耀%鬍錫琪%晉繼紅%李鋒
왕비성%왕길요%호석기%진계홍%리봉
肝炎,自身免疫性%中草药%活组织检查%实验室技术和方法
肝炎,自身免疫性%中草藥%活組織檢查%實驗室技術和方法
간염,자신면역성%중초약%활조직검사%실험실기술화방법
Hepatitis,autoimmune%Drugs,Chinese herbal%Biopsy%Laboratory techniques and procedures
目的 分析药物诱导的自身免疫性肝炎(DI-AIH)患者的临床和病理特点.方法 回顾性分析2008年1月至2011年6月接受肝活组织检查、发病前明确有药物服用史的DI-AIH患者5例,收集其基本资料,包括性别、年龄、发病和服药情况、临床表现、治疗经过和随访情况.收集其实验室检查结果,主要指标为总胆红素、直接胆红素、ALT、AST、ALP、GGT、球蛋白、γ-球蛋白百分比、白蛋白、嗜酸粒细胞、抗核抗体、抗线粒体抗体、抗平滑肌抗体,并进行肝损伤分型.患者的肝组织切片行HE染色和网状纤维染色后观察其病理变化.对DI-AIH患者进行自身免疫性肝炎(AIH)评分.结果 5例DI-AIH患者皆为女性,平均年龄为(48.0±7.5)岁,发病前均服用过中药或其制剂,纳差和乏力是最常见的临床症状.实验室检查结果中以ALT[(795.0士467.4)U/L]、AST[(730.4±451.5) U/L]、总胆红素[(80.3±64.1) μmol/L]、直接胆红素[(65.2±58.0) μmol/L]升高为主.1例患者抗核抗体阳性.1例患者存在药物性肝损伤,肝细胞点灶状坏死,肝组织嗜酸粒细胞浸润,肝细胞微泡型空泡变性.所有患者皆有界面性肝炎,汇管区淋巴细胞浸润或淋巴细胞一浆细胞浸润,病变部位相邻肝细胞呈玫瑰花结样结构.所有患者均接受糖皮质激素治疗,停药随访期间均未再出现肝功能异常.结论 DI-AIH患者的临床表现、实验室检查结果和病理检查结果缺乏特异性.
目的 分析藥物誘導的自身免疫性肝炎(DI-AIH)患者的臨床和病理特點.方法 迴顧性分析2008年1月至2011年6月接受肝活組織檢查、髮病前明確有藥物服用史的DI-AIH患者5例,收集其基本資料,包括性彆、年齡、髮病和服藥情況、臨床錶現、治療經過和隨訪情況.收集其實驗室檢查結果,主要指標為總膽紅素、直接膽紅素、ALT、AST、ALP、GGT、毬蛋白、γ-毬蛋白百分比、白蛋白、嗜痠粒細胞、抗覈抗體、抗線粒體抗體、抗平滑肌抗體,併進行肝損傷分型.患者的肝組織切片行HE染色和網狀纖維染色後觀察其病理變化.對DI-AIH患者進行自身免疫性肝炎(AIH)評分.結果 5例DI-AIH患者皆為女性,平均年齡為(48.0±7.5)歲,髮病前均服用過中藥或其製劑,納差和乏力是最常見的臨床癥狀.實驗室檢查結果中以ALT[(795.0士467.4)U/L]、AST[(730.4±451.5) U/L]、總膽紅素[(80.3±64.1) μmol/L]、直接膽紅素[(65.2±58.0) μmol/L]升高為主.1例患者抗覈抗體暘性.1例患者存在藥物性肝損傷,肝細胞點竈狀壞死,肝組織嗜痠粒細胞浸潤,肝細胞微泡型空泡變性.所有患者皆有界麵性肝炎,彙管區淋巴細胞浸潤或淋巴細胞一漿細胞浸潤,病變部位相鄰肝細胞呈玫瑰花結樣結構.所有患者均接受糖皮質激素治療,停藥隨訪期間均未再齣現肝功能異常.結論 DI-AIH患者的臨床錶現、實驗室檢查結果和病理檢查結果缺乏特異性.
목적 분석약물유도적자신면역성간염(DI-AIH)환자적림상화병리특점.방법 회고성분석2008년1월지2011년6월접수간활조직검사、발병전명학유약물복용사적DI-AIH환자5례,수집기기본자료,포괄성별、년령、발병화복약정황、림상표현、치료경과화수방정황.수집기실험실검사결과,주요지표위총담홍소、직접담홍소、ALT、AST、ALP、GGT、구단백、γ-구단백백분비、백단백、기산립세포、항핵항체、항선립체항체、항평활기항체,병진행간손상분형.환자적간조직절편행HE염색화망상섬유염색후관찰기병리변화.대DI-AIH환자진행자신면역성간염(AIH)평분.결과 5례DI-AIH환자개위녀성,평균년령위(48.0±7.5)세,발병전균복용과중약혹기제제,납차화핍력시최상견적림상증상.실험실검사결과중이ALT[(795.0사467.4)U/L]、AST[(730.4±451.5) U/L]、총담홍소[(80.3±64.1) μmol/L]、직접담홍소[(65.2±58.0) μmol/L]승고위주.1례환자항핵항체양성.1례환자존재약물성간손상,간세포점조상배사,간조직기산립세포침윤,간세포미포형공포변성.소유환자개유계면성간염,회관구림파세포침윤혹림파세포일장세포침윤,병변부위상린간세포정매괴화결양결구.소유환자균접수당피질격소치료,정약수방기간균미재출현간공능이상.결론 DI-AIH환자적림상표현、실험실검사결과화병리검사결과결핍특이성.
Objective To analyze the clinical and histological features of drug-induced autoimmune hepatitis (DI-AIH).Methods From January 2008 to June 2011,five patients with auto-immune hepatitis (AIH),having a definitive history of medicine taking prior to the onset of disease and accepted liver biopsy were retrospectively analyzed.The general information was collected,which included gender,age,onset of the disease,medication,clinical manifestations,treatment and follow-up.The laboratory findings were also collected,which included total bilirubin (TBil),direct bilirubin (DBil),alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),gamma glutamyl transpeptidase (GGT),globulin,γ-globulin percentage,albumin (Alb),eosinophils,antinuclear antibodies,antimitochondrial antibodies,anti-smooth muscle antibodies and the type of live injury.The liver tissue sections of patients were stained with hematoxylin-eosinstaining (HE) and reticular fiber staining and then pathological changes were observed.Patients with DI-AIH were scored with AIH scoring scale.Results All five patients with DI-AIH were female,average age was 48.0--+7.5.Prior to the onset of disease,all patients had taken Chinese traditional medicine.Anorexia and fatigue were the most common clinical symptoms.Among laboratory findings,the level of ALT ((795.0+467.4) U/L),AST ((730.44-451.5) U/L),TBil ((80.3-+ 64.1) μmol/L) and DBil ((65.2 +_ 58.0) μmol/L) significantly increased.One patient was antinuclear antibody positive.One patient had drug-induced liver injury,pathological features were spotty necrosis of liver cells,liver tissue eosinophil infiltration and liver cell microbubble type degeneration.All the patients had interface hepatitis,periportal infiltration of lymphocytes or lymphocytes-plasma cells,liver cells adjacent to lesion showed rosette-like structure.All the patients received glucocorticoid treatment.After glucocorticoid withdrawal,the liver function was normal during the follow-up period.Conclusion There are no specificity of clinical manifestations,laboratory findings and histological features in patients with DI-AIH.
