肝脏
肝髒
간장
CHINESE HEPATOLOGY
2015年
4期
277-280
,共4页
赖小丽%张房英%姚叶萍%吴启文
賴小麗%張房英%姚葉萍%吳啟文
뢰소려%장방영%요협평%오계문
肝炎,自身免疫性%黄疸%活组织检查
肝炎,自身免疫性%黃疸%活組織檢查
간염,자신면역성%황달%활조직검사
AIH%Jaundice%Biopsy
目的：分析以黄疸为首发表现的自身免疫性肝炎（AIH）患者临床特点。方法选取 AIH 患者63例，其中以黄疸为首发表现的患者28例和非黄疸患者35例。比较两组患者临床症状体征、血清生物化学指标、免疫学指标及肝活组织病理。结果黄疸组与非黄疸组 AIH 患者相比，在免疫学指标、自身抗体阳性率、典型组织病理学特征比较，差异均无统计学意义（Z ＝－0.224、0.318，χ2＝0.053、0.237、0.129、0.051，P 均＞0.05），而黄疸组 AIH 患者的肝肾功能指标、肝组织炎症分级和纤维化分期、胆管反应发生率、肝小叶中央区坏死程度明显高于非黄疸组（χ2＝12.504、0.026、0.009，Z ＝－2.213，P 均＜0.05）。对本次试验中接受免疫抑制剂的 AIH 患者分别进行随访，达到生物化学缓解的患者有43例，用Kaplan-Meier 法对生物化学缓解率进行分析，黄疸组患者的累积生物化学缓解率为80.5％，中位缓解时间为25个月（95％CI ：22.921～29.349）；非黄疸组患者的累积生物化学缓解率为93.2％，中位缓解时间为8 个月（95％ CI ：4.150～9.940），差异具有统计学意义（χ2＝7.139，P ＝0.008）。结论以黄疸为首发症状的急性 AIH 患者发生率较低，但肝组织损伤较为严重，治疗后缓解率较低。
目的：分析以黃疸為首髮錶現的自身免疫性肝炎（AIH）患者臨床特點。方法選取 AIH 患者63例，其中以黃疸為首髮錶現的患者28例和非黃疸患者35例。比較兩組患者臨床癥狀體徵、血清生物化學指標、免疫學指標及肝活組織病理。結果黃疸組與非黃疸組 AIH 患者相比，在免疫學指標、自身抗體暘性率、典型組織病理學特徵比較，差異均無統計學意義（Z ＝－0.224、0.318，χ2＝0.053、0.237、0.129、0.051，P 均＞0.05），而黃疸組 AIH 患者的肝腎功能指標、肝組織炎癥分級和纖維化分期、膽管反應髮生率、肝小葉中央區壞死程度明顯高于非黃疸組（χ2＝12.504、0.026、0.009，Z ＝－2.213，P 均＜0.05）。對本次試驗中接受免疫抑製劑的 AIH 患者分彆進行隨訪，達到生物化學緩解的患者有43例，用Kaplan-Meier 法對生物化學緩解率進行分析，黃疸組患者的纍積生物化學緩解率為80.5％，中位緩解時間為25箇月（95％CI ：22.921～29.349）；非黃疸組患者的纍積生物化學緩解率為93.2％，中位緩解時間為8 箇月（95％ CI ：4.150～9.940），差異具有統計學意義（χ2＝7.139，P ＝0.008）。結論以黃疸為首髮癥狀的急性 AIH 患者髮生率較低，但肝組織損傷較為嚴重，治療後緩解率較低。
목적：분석이황달위수발표현적자신면역성간염（AIH）환자림상특점。방법선취 AIH 환자63례，기중이황달위수발표현적환자28례화비황달환자35례。비교량조환자림상증상체정、혈청생물화학지표、면역학지표급간활조직병리。결과황달조여비황달조 AIH 환자상비，재면역학지표、자신항체양성솔、전형조직병이학특정비교，차이균무통계학의의（Z ＝－0.224、0.318，χ2＝0.053、0.237、0.129、0.051，P 균＞0.05），이황달조 AIH 환자적간신공능지표、간조직염증분급화섬유화분기、담관반응발생솔、간소협중앙구배사정도명현고우비황달조（χ2＝12.504、0.026、0.009，Z ＝－2.213，P 균＜0.05）。대본차시험중접수면역억제제적 AIH 환자분별진행수방，체도생물화학완해적환자유43례，용Kaplan-Meier 법대생물화학완해솔진행분석，황달조환자적루적생물화학완해솔위80.5％，중위완해시간위25개월（95％CI ：22.921～29.349）；비황달조환자적루적생물화학완해솔위93.2％，중위완해시간위8 개월（95％ CI ：4.150～9.940），차이구유통계학의의（χ2＝7.139，P ＝0.008）。결론이황달위수발증상적급성 AIH 환자발생솔교저，단간조직손상교위엄중，치료후완해솔교저。
Objective To analyze autoimmune hepatitis with first-episode jaundice or not in clinical and pathological features.Methods Sixty-three cases of autoimmune hepatitis (AIH)patients admitted to our hospital from September 2008 to April 2013 were enrolled,and were divided into jaundiced group (jaundice as first manifestation,28 cases)and non-jaundiced group (35 cases).Comparisons of clinical symptoms and signs,immunological indexes and liver function indexes of serum biochemistry between the two groups were conducted.Results Differences were not obvious between the two groups in immunological indexes,antibody positive rate and histopathological features (Z = -0.224,0.318,χ2 =0.053, 0.237,0.129,0.051 ,P > 0.05 ).However,biochemical tests,hepatic inflammatory degrees,fibrosis grades,ductular reactions and centrilobular necrosis in jaundiced group were more serious than those in non-jaundiced group (χ2 =12.504, 0.026,0.009,Z =-2.213,P <0.05).All AIH patients receiving immunization therapy in the test were followed up,of which 43 achieved biochemical remission.Cumulative biochemical remission rate in jaundiced group was 80.5% with 25 months of median duration of remission (95%CI:22.921 ~29.349),while the rate was 93.2% with 8 months of median duration of remission in non-jaundiced group (95%CI:4.150~9.940),which showed statistically significant differences (χ2=7.139,P =0.008).Conclusion Despite of a lower incidence rate,liver injury in acute AIH patients with jaundice as first symptom was serious because of low remission rate,which should be paid more attention to settling on treatment.
