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性别差异对自身免疫性肝炎患者临床特征及预后的影响

伍慧丽 时红波 刘燕敏 丁美 马正来 刘霜 陈煜 段钟平

伍慧丽, 时红波, 刘燕敏, 等. 性别差异对自身免疫性肝炎患者临床特征及预后的影响[J]. 临床肝胆病杂志, 2021, 37(7): 1636-1643. DOI: 10.3969/j.issn.1001-5256.2021.07.031
引用本文: 伍慧丽, 时红波, 刘燕敏, 等. 性别差异对自身免疫性肝炎患者临床特征及预后的影响[J]. 临床肝胆病杂志, 2021, 37(7): 1636-1643. DOI: 10.3969/j.issn.1001-5256.2021.07.031
WU HL, SHI HB, LIU YM, et al. Clinical features and prognosis of autoimmune hepatitis patients with different sexes[J]. J Clin Hepatol, 2021, 37(7): 1636-1643. DOI: 10.3969/j.issn.1001-5256.2021.07.031
Citation: WU HL, SHI HB, LIU YM, et al. Clinical features and prognosis of autoimmune hepatitis patients with different sexes[J]. J Clin Hepatol, 2021, 37(7): 1636-1643. DOI: 10.3969/j.issn.1001-5256.2021.07.031

性别差异对自身免疫性肝炎患者临床特征及预后的影响

DOI: 10.3969/j.issn.1001-5256.2021.07.031
基金项目: 

国家重点研发计划资助 2017YFA0103000

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2012ZX10002004-006

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2017ZX10203201-005

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2017ZX10201201-001-001

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2017ZX10201201-002-002

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2017ZX10201201-004-002

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2017ZX10202203-006-001

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治” 2017ZX10302201-004-002

北京市医院管理局“登峰”人才培养计划基金资助项目 DFL20151601

北京市医院管理局临床医学发展专项经费资助 ZYLX201806

科技创新服务能力建设-高精尖学科建设项目(市级) 11920703

首都医科大学重点实验室开放研究课题 BJYAHKF2017008

详细信息
    通讯作者:

    段钟平,duan@ccmu.edu.cn

  • 中图分类号: R575

Clinical features and prognosis of autoimmune hepatitis patients with different sexes

Funds: 

National Key R & D Program of China 2017YFA0103000

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2012ZX10002004-006

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2017ZX10203201-005

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2017ZX10201201-001-001

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2017ZX10201201-002-002

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2017ZX10201201-004-002

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2017ZX10202203-006-001

National Science and Technology Key Project on "Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Preventon and Treatment" 2017ZX10302201-004-002

"Beijing Muncipal Administration of Hospitals" Ascent Plan DFL20151601

Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support ZYLX201806

Science and Technology Innovation Service Capacity Building-high-precision Discipline Construction Project 11920703

Open Research Project of Key Laboratory of Capital Medical University BJYAHKF2017008

  • 摘要:   目的  自身免疫性肝炎(AIH)主要发生在女性,目前对男性AIH患者的研究甚少,本研究比较不同性别AIH之间的临床差异。  方法  收集2009年10月—2019年10月在北京佑安医院住院并确诊为AIH的患者398例进行回顾性研究,分为男(n=48)、女(n=350)两组,对一般情况、临床特点及预后等影响因素进行分析。主要研究终点为死亡或肝移植治疗。正态分布的计量资料2组间比较采用t检验,非正态分布计量资料2组间比较采用Mann-Whitney U检验。计数资料2组间比较采用χ2检验或Fisher精确概率法。采用Cox比例风险模型进行单变量和多变量分析。  结果  年龄方面,51~60岁是两组的发病高峰,但是男性在21~30岁时段确诊率明显高于女性(8/48 vs 24/334,χ2=4.915,P=0.027),而在41~50岁时段则低于女性(7/48 vs 97/334,χ2=4.428,P=0.035)。AIH分类方面,男性特发性AIH占比更高(31/48 vs 170/350,χ2=4.329,P=0.037),但男性合并其他自身免疫性疾病尤其是甲状腺功能亢进比例低于女性(0/48 vs 39/348,P=0.008)。实验室检查方面,男性ANA≥1∶ 100(42/48 vs 325/340,χ2=5.375,P=0.020) 和SSA/SSB(2/48 vs 76/340,χ2=7.566,P=0.006)阳性率显著低于女性患者;男性ANA ≥1∶ 1000的比率显著低于女性(P<0.000 1)。预后方面,男性出现死亡或接受肝移植的年龄要远小于女性[(31.5±15.9)岁vs (53.9±12.6)岁,t=3.798,P=0.001],男性失代偿期肝硬化及肝细胞癌发生更多见(P值均<0.05)。与生存期下降有关的高危因素,男性: 糖尿病、肝硬化以及血Alb<31.4 g/L,女性: 肝衰竭、肝硬化、ANA≥1∶ 1000、DBil>42 μmol/L、淋巴细胞计数<1.2×109/L以及补体C3<0.588 g/L(P值均<0.05)。  结论  性别差异对AIH患者临床表现和预后有一定影响,主要表现在男性患者更年轻、预后更差。

     

  • 图  1  不同性别的AIH患者按发病年龄段进行分组比较结果

    表  1  不同性别患者一般资料比较

    指标 例数 男性 女性 统计值 P
    随访时间(月) 367 60.3±46.4 74.2±54.0 t=1.658 0.098
    发病年龄(岁) 392 46.8(6.0~79.0) 50.1(3.0~85.0) Z=1.195 0.115
    发病年龄段[例(%)]
        0~10岁 4 1/48(2.1) 3/334(0.9) χ2=0.000 1.000
        11~20岁 8 2/48(4.2) 6/334(1.8) χ2=0.284 0.594
        21~30岁 32 8/48(16.7) 24/334(7.2) χ2=4.915 0.027
        31~40岁 40 6/48(12.5) 34/334(10.2) χ2=0.241 0.623
        41~50岁 104 7/48(14.6) 97/334(29.0) χ2=4.428 0.035
        51~60岁 105 14/48(29.2) 91/334(27.2) χ2=0.078 0.780
        61~70岁 71 9/48(18.8) 62/334(18.6) χ2=0.001 0.975
        >70岁 18 1/48(2.1) 17/334(5.1) χ2=0.308 0.579
    诊断年龄(岁) 392 48.0(6.0~79.0) 51.0(3.0~85.0) Z=-0.491 0.623
    诊断用时(月) 374 9.0(0~126.0) 13.9(0~241.0) Z=-1.940 0.052
    无症状体检发现[例(%)] 83 4/45(8.9) 79/334(30.0) χ2=3.897 0.048
    AIH分类[例(%)]
        I-AIH 201 31/48(64.6) 170/350(48.6) χ2=4.329 0.037
        DI-AIH 115 9/48(18.8) 106/350(30.3) χ2=2.734 0.098
        OS 77 8/48(16.7) 69/350(27.6) χ2=0.251 0.616
        DI-AIH合并OS 5 0/48(0) 5/350(1.4) 1.000
    肝硬化[例(%)] 168 20/47(42.6) 148/339(43.7) χ2=0.020 0.886
        失代偿 78 14/20(70.0) 64/148(43.2) χ2=5.071 0.024
    糖尿病[例(%)] 55 6/45(13.3) 49/316(15.5) χ2=0.144 0.704
    肝衰竭[例(%)] 57 6/48(12.5) 51/350(14.6) χ2=0.148 0.701
    合并其他免疫病[例(%)] 169 14/48(29.2) 155/348(44.5) χ2=4.075 0.044
        自身免疫性甲状腺疾病 45 1/48(2.2) 44/348(12.6) χ2=3.681 0.055
            甲状腺功能亢进 39 0/48(0) 39/348(11.2) 0.008
            甲状腺功能减弱 6 1/48(2.1) 5/348(1.4) χ2=0.000 1.000
        PBC 70 6/48(13.3) 64/348(18.4) χ2=1.006 0.316
        PSC 3 1/48(2.2) 2/348(0.6) χ2=0.059 0.809
        SLE 10 1/48(2.2) 9/348(2.6) χ2=0.000 1.000
        干燥综合征 36 2/48(4.2) 34/348(9.8) χ2=0.996 0.318
    下载: 导出CSV

    表  2  男性和女性AIH患者实验室检查结果

    指标 例数 男性 女性 统计值 P
    ALT(U/L) 390 514(12~2255) 372(4~2270) Z=-1.058 0.290
    AST(U/L) 389 342(21~1725) 380(16~2094) Z=-0.568 0.570
    TBil(μmol/L) 385 88.1(8.3~535.1) 100.2(5.8~765.7) Z=-0.696 0.486
    DBil(μmol/L) 378 61.8(1.9~383.0) 65.4(0.9~603.0) Z=-0.191 0.849
    GGT(U/L) 375 209(24~951) 174(11~1357) Z=-1.034 0.306
    ALP(U/L) 373 176(64~966) 182(27~1189) Z=-0.555 0.579
    TBA(μmol/L) 365 82.7(2.7~368.8) 80.0(1.3~319.0) Z=-0.417 0.676
    Alb(g/L) 379 35.30±8.31 35.10±6.28 t=-0.124 0.902
    GLOB(g/L) 375 40.6±13.2 38.8±9.2 t=-0.838 0.407
    ChE(U/L) 364 4642±2382 4785±2073 t=0.395 0.693
    WBC(×109) 374 5.7(2.2~12.5) 4.8(1.4~12.0) Z=-2.476 0.013
    NE(×109) 363 2.70(2.07~3.85) 2.35(1.68±3.18) Z=-2.500 0.012
    LY(×109) 360 1.80±0.77 1.60±0.66 t=-1.460 0.151
    Hb(g/L) 371 131.0±24.6 118.0±17.0 t=-3.427 0.001
    PLT(×109) 370 163±75 161±77 t=-0.193 0.847
    IgG(g/L) 377 25.6±11.5 24.6±8.9 t=-0.634 0.527
    IgM(g/L) 371 1.39(0.89~2.53) 1.72(1.19~2.63) Z=-1.609 0.108
    C3(g/L) 365 0.96±0.34 0.94±0.38 t=-0.417 0.677
    C4(g/L) 365 0.16(0.10~0.25) 0.15(0.10~0.21) Z =-0.815 0.415
    注:TBA,总胆汁酸;GLOB,球蛋白;ChE,胆碱酯酶;LY,淋巴细胞。
    下载: 导出CSV

    表  3  男性和女性AIH患者血清自身抗体及核型

    指标 例数 男性 女性 χ2 P
    自身抗体阳性[例(%)] 388 48/48(100) 340/350(97.1) 0.617
        ANA≥1∶100 367 42/48(87.5) 325/340(95.6) 5.375 0.020
        ANA≥1∶1000 217 11/48(22.9) 206/340(60.6) 24.217 <0.001
        SMA≥1∶100 54 5/48(10.4) 49/340(14.4) 0.560 0.454
        SMA≥1∶1000 8 1/48(2.1) 7/340(2.1) 0.000 1.000
        AMA≥1∶320 84 7/48(14.6) 77/340(22.6) 1.612 0.204
        LKM-1 12 3/48(6.3) 9/340(2.6) 0.818 0.366
        SLA/LP 24 1/48(2.1) 23/340(6.8) 0.884 0.347
        SSA/SSB 78 2/48(4.2) 76/340(22.4) 7.566 0.006
        GP210 23 3/48(6.3) 20/340(5.9) 0.000 1.000
        Sp100 15 1/48(2.1) 14/340(4.1) 0.081 0.776
    ANA核型[例(%)]
        核颗粒型 109 9/13(69.2) 100/154(64.9) 0.098 0.775
        胞浆颗粒型 65 5/13(38.5) 60/154(39.0) 0.001 0.972
        核均质型 59 4/13(30.8) 55/154(35.7) 0.003 0.955
        核膜型 12 1/13(7.7) 11/154(7.1) 0.000 1.000
        着丝点型 5 1/13(7.7) 4/154(2.6) 0.035 0.851
        核仁型 9 0/13(0) 9/154(5.8) 0.000 1.000
    下载: 导出CSV

    表  4  男性和女性AIH嗜肝病毒感染情况

    指标 例数 男性 女性 χ2 P
    HAV-IgG[例(%)] 333 35/35(100.0) 297/298(99.7) 1.000
    抗-HBc阳性且HBsAg阴性[例(%)] 155 21/31(67.7) 134/291(46.0) 5.281 0.022
        肝硬化 80 10/21(47.6) 70/134(52.2) 0.155 0.694
        死亡或肝移植 18 4/21(19.0) 14/70(20.0) 0.000 1.000
    HCV-IgG[例(%)] 6 0/35(0) 6/264(2.3) 1.000
    HEV-IgG[例(%)] 55 3/16(18.8) 52/221(23.5) 0.017 0.896
    EBV-IgG[例(%)] 30 0/17(0) 30/211(14.2) 0.138
    CMV-IgG[例(%)] 115 13/19(68.4) 102/209(48.8) 2.681 0.102
    PVB19-IgG[例(%)] 47 3/15(20.0) 44/126(34.9) 0.755 0.385
    下载: 导出CSV

    表  5  男性和女性AIH治疗及预后情况

    指标 例数 男性 女性 统计值 P
    治疗[例(%)] 224 28/48(56.3) 196/350(56.0) χ2=0.093 0.974
        单用皮质醇激素 156 15/28(55.6) 141/196(71.9) χ2=3.910 0.048
        单用硫唑嘌呤 5 1/28(3.7) 4/196(2.0) χ2=0.000 1.000
        皮质醇激素和硫唑嘌呤 62 11/28(40.7) 51/196(26.0) χ2=2.154 0.142
        二线药物 6 2/28(7.4) 4/196(2.0) χ2=0.881 0.348
    治疗有效[例(%)] 214 28/28(82.4) 186/196(92.1) 0.618
        停药或减量后反弹 84 13/28(38.2) 71/196(36.2) χ2=1.088 0.297
        依从性好 214 27/28(92.9) 187/196(94.9) χ2=0.000 1.000
    药物不良反应[例(%)] 111 15/28(53.6) 96/196(49.0) χ2=0.207 0.649
        感染 68 10/28(35.7) 58/196(29.6) χ2=0.434 0.510
        骨质疏松 13 4/28(14.3) 9/196(4.6) χ2=2.625 0.105
        其他 35 6/28(21.4) 29/196(14.7) χ2=0.818 0.366
    结局[例(%)]
        HCC 10 4/48(8.3) 6/350(1.7) χ2=5.090 0.024
        肝移植 17 2/48(4.2) 15/350(4.3) χ2=0.052 0.820
    肝病相关死亡 36 7/48(14.6) 29/350(8.3) χ2=2.035 0.154
    死亡或接受肝移植年龄(岁) 36 31.5±15.9 53.9±12.6 t=3.798 0.001
    死亡或肝移植患者总生存期(月) 36 41.8±37.2 44.9±53.9 t=0.137 0.891
    下载: 导出CSV

    表  6  影响AIH患者预后的高危因素

    因素 HR 95%CI P
    男性
        肝硬化 3.250 1.356~7.793 0.008
        糖尿病 17.532 1.638~18.611 0.018
        Alb<31.4 g/L 32.518 2.264~46.109 0.010
    女性
        肝硬化 2.923 1.251~6.828 0.013
        肝衰竭 3.355 1.340~8.397 0.010
        ANA≥1∶1000 0.045 0.003~0.625 0.021
        DBil>42 μmol/L 0.344 0.128~0.926 0.035
        LY<1.2×109/L 5.408 1.776~16.464 0.003
        C3<0.588 g/L 4.043 1.559~10.480 0.004
    下载: 导出CSV
  • [1] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis[J]. J Hepatol, 2015, 63(4): 971-1004. DOI: 10.1016/j.jhep.2015.06.030.
    [2] TAUBERT R, JAECKEL E. Autoimmunhepatitis-Standard- und Zweitlinientherapie [Autoimmune hepatitis-standard and second-line therapy][J]. Internist (Berl), 2018, 59(6): 536-543. DOI: 10.1007/s00108-018-0434-1.
    [3] PUUSTINEN L, BOYD S, MUSTONEN H, et al. Prognostic value of clinical variables and liver histology for development of fibrosis and cirrhosis in autoimmune hepatitis[J]. Scand J Gastroenterol, 2017, 52(3): 321-327. DOI: 10.1080/00365521.2016.1253768.
    [4] ∅RSTAVIK KH. Why are autoimmune diseases more prevalent in women?[J]. Tidsskr Nor Laegeforen, 2017, 137(12-13): 866-868. DOI: 10.4045/tidsskr.16.0935.
    [5] LIBERT C, DEJAGER L, PINHEIRO I. The X chromosome in immune functions: When a chromosome makes the difference[J]. Nat Rev Immunol, 2010, 10(8): 594-604. DOI: 10.1038/nri2815.
    [6] MOULTON VR. Sex hormones in acquired Immunity and autoimmune disease[J]. Front Immunol, 2018, 9: 2279. DOI: 10.3389/fimmu.2018.02279.
    [7] RIBBONS KA, MCELDUFF P, BOZ C, et al. Male sex is independently associated with faster disability accumulation in relapse-onset MS but not in primary progressive MS[J]. PLoS One, 2015, 10(6): e0122686. DOI: 10.1371/journal.pone.0122686.
    [8] ABDULKARIM M, ZENOUZI R, SEBODE M, et al. Sex differences in clinical presentation and prognosis in patients with primary biliary cholangitis[J]. Scand J Gastroenterol, 2019, 54(11): 1391-1396. DOI: 10.1080/00365521.2019.1683226.
    [9] LUCEY MR, NEUBERGER JM, WILLIAMS R. Primary biliary cirrhosis in men[J]. Gut, 1986, 27(11): 1373-1376. DOI: 10.1136/gut.27.11.1373.
    [10] SAYINER M, GOLABI P, STEPANOVA M, et al. Primary biliary cholangitis in medicare population: The impact on mortality and resource use[J]. Hepatology, 2019, 69(1): 237-244. DOI: 10.1002/hep.30174.
    [11] SHAHARIR SS, KADIR WDA, NORDIN F, et al. Systemic lupus erythematosus among male patients in Malaysia: How are we different from other geographical regions?[J]. Lupus, 2019, 28(1): 137-144. DOI: 10.1177/0961203318812676.
    [12] AL-CHALABI T, UNDERHILL JA, PORTMANN BC, et al. Impact of gender on the long-term outcome and survival of patients with autoimmune hepatitis[J]. J Hepatol, 2008, 48(1): 140-147. DOI: 10.1016/j.jhep.2007.08.013.
    [13] MONTANO-LOZA AJ, CARPENTER HA, CZAJA AJ. Predictive factors for hepatocellular carcinoma in type 1 autoimmune hepatitis[J]. Am J Gastroenterol, 2008, 103(8): 1944-1951. DOI: 10.1111/j.1572-0241.2008.01922.x.
    [14] DONET JA, PERLINI EF, GILINSKY D, et al. Impact of gender on clinical presentation, response to treatment, and long-term outcomes in an ethnically diverse population of patients with autoimmune hepatitis[J]. J Hepatol, 2016, 64(2): s439. http://www.researchgate.net/publication/308577254_Impact_of_Gender_on_Clinical_Presentation_Response_to_Treatment_and_Long-Term_Outcomes_in_an_Ethnically_Diverse_Population_of_Patients_with_Autoimmune_Hepatitis
    [15] HENNES EM, ZENIYA M, CZAJA AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology, 2008, 48(1): 169-176. DOI: 10.1002/hep.22322.
    [16] ALVAREZ F, BERG PA, BIANCHI FB, et al. International Autoimmune Hepatitis Group Report: Review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol, 1999, 31(5): 929-938. DOI: 10.1016/s0168-8278(99)80297-9.
    [17] WEILER-NORMANN C, SCHRAMM C. Drug induced liver injury and its relationship to autoimmune hepatitis[J]. J Hepatol, 2011, 55(4): 747-749. DOI: 10.1016/j.jhep.2011.02.024.
    [18] YEONG TT, LIM KH, GOUBET S, et al. Natural history and outcomes in drug-induced autoimmune hepatitis[J]. Hepatol Res, 2016, 46(3): e79-e88. DOI: 10.1111/hepr.12532.
    [19] CHAZOUILLÈRES O, WENDUM D, SERFATY L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Clinical features and response to therapy[J]. Hepatology, 1998, 28(2): 296-301. DOI: 10.1002/hep.510280203.
    [20] BOBERG KM, CHAPMAN RW, HIRSCHFIELD GM, et al. Overlap syndromes: The International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue[J]. J Hepatol, 2011, 54(2): 374-385. DOI: 10.1016/j.jhep.2010.09.002.
    [21] FUKUI H, SAITO H, UENO Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015[J]. J Gastroenterol, 2016, 51(7): 629-650. DOI: 10.1007/s00535-016-1216-y.
    [22] GRR∅NBAK L, VILSTRUP H, JEPSEN P. Autoimmune hepatitis in Denmark: Incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study[J]. J Hepatol, 2014, 60(3): 612-617. DOI: 10.1016/j.jhep.2013.10.020.
    [23] XUE M, SHEN Y, SHEN MY, et al. Autoimmune hepatitis-related autoantibodies and their clinical significance[J]. J Clin Hepatol, 2019, 35(6): 1392-1396. DOI: 10.3969/j.issn.1001-5256.2019.06.048.

    雪梅, 沈怡, 沈梦益, 等. 自身免疫性肝炎相关自身抗体及临床意义[J]. 临床肝胆病杂志, 2019, 35(6): 1392-1396. DOI: 10.3969/j.issn.1001-5256.2019.06.048.
    [24] ZHANG WC, ZHAO FR, CHEN J, et al. Meta-analysis: Diagnostic accuracy of antinuclear antibodies, smooth muscle antibodies and antibodies to a soluble liver antigen/liver pancreas in autoimmune hepatitis[J]. PLoS One, 2014, 9(3): e92267. DOI: 10.1371/journal.pone.0092267.
    [25] CZAJA AJ. Behavior and significance of autoantibodies in type 1 autoimmune hepatitis[J]. J Hepatol, 1999, 30(3): 394-401. DOI: 10.1016/s0168-8278(99)80096-8.
    [26] DINSER R, BRAUN A, JENDRO MC, et al. Increased titres of anti-nuclear antibodies do not predict the development of associated disease in the absence of initial suggestive signs and symptoms[J]. Scand J Rheumatol, 2007, 36(6): 448-451. DOI: 10.1080/03009740701406577.
    [27] VALGEIRSSON KB, HREINSSON JP, BJÖRNSSON ES. Increased incidence of autoimmune hepatitis is associated with wider use of biological drugs[J]. Liver Int, 2019, 39(12): 2341-2349. DOI: 10.1111/liv.14224.
    [28] FLOREANI A, DE MARTIN S, SECCHI MF, et al. Extrahepatic autoimmunity in autoimmune liver disease[J]. Eur J Intern Med, 2019, 59: 1-7. DOI: 10.1016/j.ejim.2018.10.014.
    [29] MURATORI P, FABBRI A, LALANNE C, et al. Autoimmune liver disease and concomitant extrahepatic autoimmune disease[J]. Eur J Gastroenterol Hepatol, 2015, 27(10): 1175-1179. DOI: 10.1097/MEG.0000000000000424.
    [30] WONG GW, YEONG T, LAWRENCE D, et al. Concurrent extrahepatic autoimmunity in autoimmune hepatitis: Implications for diagnosis, clinical course and long-term outcomes[J]. Liver Int, 2017, 37(3): 449-457. DOI: 10.1111/liv.13236.
    [31] GOWER E, ESTES C, BLACH S, et al. Global epidemiology and genotype distribution of the hepatitis C virus infection[J]. J Hepatol, 2014, 61(1 Suppl): S45-S57. DOI: 10.1016/j.jhep.2014.07.027.
    [32] REZAEE ZAVAREH MS, ALAVIAN SM, KARIMISARI H, et al. Occult hepatitis C virus infection in patients with autoimmune hepatitis[J]. Hepat Mon, 2014, 14(8): e16089. DOI: 10.5812/hepatmon.16089.
    [33] MENG J. Epidemiological survey of hepatitis B virus infection in hospitals: A cross-sectional study[D]. Changchun: Jilin University, 2016.

    孟静. 乙型肝炎病毒感染医院流行病学调查: 一项横断面研究y[D]. 长春: 吉林大学, 2016.
    [34] TAUBERT R, DIESTELHORST J, JUNGE N, et al. Increased seroprevalence of HAV and parvovirus B19 in children and of HEV in adults at diagnosis of autoimmune hepatitis[J]. Sci Rep, 2018, 8(1): 17452. DOI: 10.1038/s41598-018-35882-7.
    [35] PARKER R, OO YH, ADAMS DH. Management of patients with difficult autoimmune hepatitis[J]. Therap Adv Gastroenterol, 2012, 5(6): 421-437. DOI: 10.1177/1756283X12450251.
    [36] TANSEL A, KATZ LH, EL-SERAG HB, et al. Incidence and determinants of hepatocellular carcinoma in autoimmune hepatitis: A systematic review and meta-analysis[J]. Clin Gastroenterol Hepatol, 2017, 15(8): 1207-1217.e4. DOI: 10.1016/j.cgh.2017.02.006.
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  • 收稿日期:  2020-12-27
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