自身免疫性肝炎与病毒性肝炎的临床病理特点对照研究

Objective To explore the character of clinical manifestations and liver pathological features of autoimmune hepatitis (AIH) and improve the diagnostic accuracy in early stage of AIH patients. Methods 78 patients with AIH,31 patients with acute viral hepatitis(AH) and 31 patients with chronic hepatitis B (CHB) were collected. The liver function and immunoglobulins were compared among them as well as the comparison of chronic and acute onset AIH groups. A part of patients underwent liver, biopsy and HBsAg immunohistochemistry examination. Results AIH patients were dominated by female (94.87%) over 40 years old (78.21%). The level of AST/ALT, γ-glutamyl transferase (CGT), alkaline phosphatase(ALP), IgG, IgM and γ-globulin in AIH group were significantly higher than those in CHB and AH groups. Furthermore, the level of γ-globulin in chronic AIH group was higher than that in acute onset AIH group (P< 0.05). The positive rate of smooth muscle antibody(SMA) was 6.41%, and the positive rate of anti-nuclear antibody(ANA) was 79.49% in AIH patients. There was no difference in the titer of ANA between acute and chronic AIH groups(P> 0.03). Regarding the appearance of liver pathology, it was easy to distinguish AIH from AH, but difficult to differentiate AIH from CHB. liver tissues, loose degeneration, spotty necrosis and piecemeal necrosis accompanying with bridging necrosis were very common in AM. There were great numbers of lymphocyte infiltration in portal area that was often accompanied with varying degrees of fibrosis. The degree of hepatic inflammation and fibrosis were similar in acute and chronic AIH ( P > 0.05). Ihe degree of hepatic lesions in 2 AIH patients suffered with subacute liver failure didn' t agree with the severe clinical manifestations. Conclusions AIH patients are dominated with female over 40-year-old who often accompanied with elevation of AST/ALT, GGT, ALP and y-globulin as well as the appearance autoantibodies. The appearance of liver pathology is multiplicity that piecemeal of necrosis accompanying with bridging necrosis and lymphocytes infiltration is common. The degree of hepatic lesions is similar in aeute and chronic AIH. It's important to check the liver tissue for diagnose in early stage correctly.

Comparative study of clinical and pathological features between autoimmune hepatitis and viral hepatitis