自身免疫性肝病临床及实验室特征分析

目的 比较自身免疫性肝炎(AIH)、原发性胆汁性胆管炎(PBC)和AIH/PBC重叠综合征(OS)的临床和实验室特征,探讨抗平滑肌抗体(ASMA)阳性/阴性的AIH、抗线粒体抗体(AMA)阳性/阴性的PBC的肝功能生化指标、血常规、凝血象是否存在差异,帮助临床及时诊断和治疗。方法 收集自身免疫性肝病患者169例,分析临床特征及实验室相关检测结果。结果 自身免疫性肝病(AILD)患者都可出现乏力、纳差、腹胀的症状及脾大、腹水和皮肤巩膜黄染的体征,AIH男女比例为1∶3.8,PBC男女比例为1∶11.8,AIH/PBC OS男女比例为1∶10.0。AIH患者血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆红素(TBIL)明显升高,而PBC患者碱性磷酸酶(ALP)升高明显。PBC相比AIH更容易引起血红蛋白(Hb)、血小板(PLT)的减少,而AIH更易引起凝血酶原时间(TT)的升高。AIH与PBC患者抗核抗体(ANA)阳性率差异无统计学意义(P<0.05),ASMA和AMA/AMA-M2阳性率差异有统计学意义(P<0.05)。ASMA阳性组和阴性组AIH患者的活化部分凝血酶时间(APTT),AMA阳性组和阴性组PBC患者的白细胞(RBC)比较差异有统计学意义(P<0.05)。结论 AILD有着相似的临床特征和相对特异的实验室结果,结合临床和实验室特征综合分析可帮助临床医生更好地鉴别AILD的类型,辅助临床诊断及治疗。ASMA与AIH、AMA与PBC病情的严重程度是否有明显相关性,还需进一步研究探讨。

Clinical and laboratory characteristics of autoimmune liver disease

Objective To compare the clinical and laboratory characteristics of autoimmune hepatitis(AIH),primary biliary cholangitis(PBC)and AIH/PBC overlap syndrome(OS),and to investigate whether there is a difference between ASMA-positive/negative AIH,AMA-positive/negative PBC in biochemical liver function,blood routine and coagulation results,assisting clinical diagnosis and treatment in time.Methods 169 patients with autoimmune liver disease were collected and analyzed for clinical features and laboratory results.Results AILD patients may have symptoms of fatigue,anorexia,abdominal distension and signs of splenomegaly,ascites and scleral yellowing of the skin.The ratio of AIH men to women was 1∶3.8,PBC male to female was 1∶11.8,and the AIH/PBC OS was 1∶10.0.Alanine amintransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)levels were significantly increased in AIH patients,while ALP level was significantly higher in PBC patients.PBC was more likely to cause decreased hemoglobin(Hb)and platelet(PLT)than AIH,while AIH was more likely to cause elevated TT.There was no significant difference in the positive rate of ANA between AIH and PBC patients(P>0.05),while the positive rates of ASMA and AMA/AMA-M2 were significantly different(P<0.05).The difference of APTT between ASMA positive and negative AIH patients,and RBC between AMA positive and negative PBC patients were significant(P<0.05).Conclusion AILD had similar clinical features and specific laboratory results.Comprehnesive analysis combining with clinical and laboratory characteristics could help clinicians to better identify the type of AILD,aiding clinical diagnosis and treatment.Further studies are needed to investigate whether ASMA and AMA are correlated with the severity of AIH and PBC.