老年自身免疫性肝炎患者临床检验特点分析

目的 探讨老年自身免疫性肝炎（AIH）患者临床检验特点。方法 回顾性分析2005年1月~2015年12月期间收治的133例AIH患者的临床资料,年龄<60岁者85例,≥60岁者48例。统计分析两组患者临床资料、生化指标和免疫学指标等差异。结果 21.3%老年组和20.0%非老年组合并干燥综合征,合并自身免疫性甲状腺炎分别为8.3%和10.6%,合并类风湿性关节炎分别为10.4%和4.7%（P<0.05）;老年患者血清ALT、AST和ALP呈低水平升高,GGT明显升高,γ-球蛋白和IgG均超过最高上限;老年组和非老年组抗核抗体阳性率分别为80.5%和77.0%,AMA分别为51.7%和55.9%,SSA阳性率分别为23.3%和15.2%,ENA分别为8.3%和7.7%（P>0.05）,非老年组DsDNA阳性率为6.3%,两组均未检出SLA/LP、LC-1和LKM;老年组红细胞MCV和MCH明显高于非老年组（P<0.05）,血Cr、Urea和胱抑素C （Cys-c）也显著高于非老年组（P<0.01）;老年组β-球蛋白显著低于非老年组,差异有统计学意义（P<0.01）。结论 老年AIH患者在合并肝外自身免疫性疾病、血生化指标、自身抗体、γ-球蛋白和IgG水平等方面与非老年组类似,但老年患者红细胞MCV和MCH明显增大,提示可能合并自身免疫性胃炎,Cys-C升高提示老年AIH患者可能合并肾脏免疫性损伤,β-球蛋白增高提示易发生肝内胆汁淤积,DsDNA仅见于非老年患者,提示中青年患者易合并多器官自身免疫病。

Clinical examination characteristics of elderly patients with autoimmune hepatitis

Objective To explore the clinical characteristics of elderly patients with autoimmune hepatitis （AIH）. Methods 133 patients with AIH in our hospital between Jan.2005 and Dec.2015 were selected in this study. The age was 13 to 83 years-old with mean age of（55.20±12.91） years old,and the male were 20 and female were 113 cases;Patients younger than 60 years old（non-elderly group） were 85 cases,and elderly group older than 60 were 48 cases. Statistically analysis was applied to compare the clinical manifestations,biochemical indicators,immunological indexes in the two groups. Results Women were significantly more than men in patients with AIH in this study,and the coexistence of Sjogren's syndrome in non- elderly group was 20.0%,and 31.3% in the elderly group,autoimmune thyroiditis were 10.6% and 8.3%,and rheumatoid arthritis were 4.7% and 10.4% in the two groups;serum ALT,AST and ALP levels increased at a low levels,serum GGT levels increased significantly,and blood γ-globulin and IgG increased at a maximum limit of normal references;the positive rates of ANA were 80.5% in elderly group and 77.0% in non-elderly group,the AMA were 51.7% and 55.9%, the SSA were 23.3% and 15.2%,the ENA were 8.3% and 7.7%,and the DsDNA was only positive in non-elderly group （6.3%）,and the SLA/LP,LC-1 and LKM did not check out in the two groups;MCV and average of MCH in the elderly group were obviously higher than those in the non-elderly group （P<0.05）;serum Cr,urea and Cys-C levels in the elderly group was significantly higher than in the non-elderly group,and the differences between the two groups was statistically significant（P<0.01）;serum β-globulin in the non-elderly group was much higher than in the elderly group（P<0.01）. Conclusion The elderly AIH patients is similar to the non-elderly group in clinical manifestations, complicated by extrahepatic incidence of autoimmune diseases,liver biochemistry,autoantibodies,γ-globulin and IgG levels;But the MCV and MCH in the elderly group are significantly larger,suggesting that the elderly patients may be deteriorated by autoimmune gastritis;the rise of serum Cys-C in elderly patients suggests that they may be with kidney damage and serum β-globulin levels increase at a low levels in the non-elderly patients,hinting that they are prone to intrahepatic cholestasis;DsDNA is restricted to the non-elderly patients,implying that they are easy to have multiple autoimmune organ diseases.