自身免疫性肝炎与系统性红斑狼疮性肝损伤临床特征对比

目的比较自身免疫性肝炎（AIH）与系统性红斑狼疮（SLE）性肝损伤在临床表现、血清学检查及病理学上的异同点。方法回顾性分析44例自身免疫性肝炎与26例狼疮性肝损伤的临床资料、血清学检查及病理学特点。结果AIH以女性多发，发病高峰为（47.32±13.61）岁，临床表现以消化系统为主，以ALT、AST升高，高球蛋白血症及IgG升高为主要特征，存在多种自身抗体，伴发其他自身免疫性疾病比率高，病理有特征性改变，对激素及免疫抑制剂有效，病情呈波动性变化。SLE以女性多发，发病高峰（33.46±14.32）岁，临床表现多样化，肝损伤为初发患者一过性ALT、AST升高，有明显低补体血症，存在多种自身抗体，并发其他自身免疫性疾病比率低，病理无特征性改变，激素治疗有效。结论AIH、SLE均以女性多发，有过敏史的比率高于正常人群，激素治疗有效；AIH肝损伤重，呈波动性变化，易伴发其他自身免疫性疾病，SLE肝损伤轻，多为一过性，可累及全身多个系统，二者为相互独立的疾病。

A comparison of autoimmune hepatitis and systemic lupus erythematosus-associated hepatitis

Objective To investigate the clinical and pathological characteristics of autoimmune hepatitis （AIH） and systemic lupus erythematosus （SLE）-associated hepatitis. Methods The clinical and pathological characteristics by liver biopsy of 44 AIH patients were retrospectively compared with that of 26 SLE-associated hepatitis patients. Results Most AIH patients were females, with the age of （47.32±13.61） years old. Their clinical manifestations were mainly the symptoms of digestive system, with elevated ALT and AST, hyperglobulinemia, hypergammaglobulinemia, different kinds of autoantibodies and high incidence rate of other autoimmune diseases. Patients usually had fluetuant pathogenetic conditions with specific pathological changes, most of which were moderate to severe chronic hepatitis, and hormones or immunosuppressive agents therapy was effective. Most SLE patients were females too, with the age of （33.46±14.32） years old. Their clinical manifestations were diverse, with temporary elevation of ALT and AST at the beginning, hypocomplementemia, different kinds of autoantibodies and low incidence rate of other autoimmune diseases. Their pathologic changes were all mild chronic hepatitis, without specificity, and hormone therapy was also effective. Conclusion Most of AIH and SLE patients were females, with a higher rate of hypersensitive history than normal population, and hormone therapy was effective. AIH patients usually had fluctuant pathogenetic conditions and severe liver impairment with many other autoimmune diseases. SLE patients usually had temporary mild liver impairment with many other symptoms due to multisystemic damage. AIH was a distinct disease and was completely different from SLE-associated hepatitis.