不同年龄组自身免疫性肝炎患者的临床特征分析

目的分析并比较不同年龄组自身免疫性肝炎（AIH）患者的临床特征、生化指标、免疫学指标和病理特点。方法 98例AIH患者按年龄分为青年（〈45岁）、中年（45～60岁）和老年（〉60岁）三组,回顾性比较三组患者临床特征、生化指标、免疫学指标、自身抗体和病理特点。结果老年组有并发症者显著高于青年组（50%vs 20%,P〈0.05）,其中,老年组肝硬化比例高于青年组（40.6%vs 5.7%,P〈0.05）。老年组TBil水平显著高于青年组,差异有统计学意义（P〈0.05）。中、老年组血清C4水平显著低于青年组（P〈0.05）;而lgG、lgM、lgA、C3水平差异无统计学意义。老年组抗核抗体（ANA）阳性率显著高于青年组（100%vs77.1%,P〈0.05）;青年组抗平滑肌抗体（SMA）阳性率显著高于老年组（31.4%vs 6.3%,P〈0.05）。中、老年组肝组织学界面炎比例显著高于青年组（88.5%、100%vs 51.8%,P〈0.05）;肝组织学炎症活动度评分（HAI）比较,中、老年组HAI高于靑年组差异有统计学意义（P〈0.05）。结论老年AIH患者在发病时肝硬化发生率高、肝病相关并发症比例高,肝脏炎症活动较重。

Age-related clinical features of autoimmune hepatitis

Objective To analyze and compare the clinical manifestations,biological and chemical indices,immunological indices,and liver biopsy histological features of autoimmune hepatitis（AIH） according to patient age.Methods Ninety-eight adult Chinese patients diagnosed with AIH were divided into three groups according to age：45 years old（young）,45-60 years old（middle-aged）,and 60 years old（elderly）.Significance of inter-group differences in the clinical manifestations,biological and chemical indices,immunological indices,and liver biopsy histology was assessed by ANOVA（normally distributed data） or Wilcoxon rank test（non-normally distributed data）.Results The elderly patients had a significantly higher frequency of hepatopathy than the young patients（50% vs.20%,P0.05） and a higher frequency of cirrhosis than either the young patients（40.6% vs.5.7%,P0.05）.The elderly patients also had higher levels of total bilirubin（TBil） than the young patients（P0.05）.The level of serum complement factor 4（C4） was remarkably lower in the middle-aged patients and elderly patients than in the young patients（P0.05）.The elderly patients had a higher frequency of antinuclear autoantibodies（ANA） positivity but lower frequency of anti-smooth muscle autoantibodies（SMA） positivity than the young patients（ANA：100% vs.77.1%,P0.05;SMA：31.4% vs.6.3%,P0.05）.The middle-aged and elderly patients had higher frequencies of interface hepatitis than the young patients（88.5% and 100% vs.51.8%,P0.05）.The histology activity index（HAI） was also remarkably higher in the middle-aged and elderly patients than in the young patients（8.1±2.8 and 10.2±3.6 vs.6.6±2.3,P0.05）.Conclusion Elderly AIH patients have higher frequencies of cirrhosis and complications,as well as stronger inflammatory activities.