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慢性肝病合并自身免疫性血液系统疾病的临床特征及应用糖皮质激素治疗效果分析

刘龙 刘遥 高方媛 王宪波

刘龙, 刘遥, 高方媛, 等. 慢性肝病合并自身免疫性血液系统疾病的临床特征及应用糖皮质激素治疗效果分析[J]. 临床肝胆病杂志, 2021, 37(8): 1878-1882. DOI: 10.3969/j.issn.1001-5256.2021.08.025
引用本文: 刘龙, 刘遥, 高方媛, 等. 慢性肝病合并自身免疫性血液系统疾病的临床特征及应用糖皮质激素治疗效果分析[J]. 临床肝胆病杂志, 2021, 37(8): 1878-1882. DOI: 10.3969/j.issn.1001-5256.2021.08.025
LIU L, LIU Y, GAO FY, et al. Clinical features of chronic liver disease with autoimmune blood diseases and the clinical effect of glucocorticoid[J]. J Clin Hepatol, 2021, 37(8): 1878-1882. DOI: 10.3969/j.issn.1001-5256.2021.08.025
Citation: LIU L, LIU Y, GAO FY, et al. Clinical features of chronic liver disease with autoimmune blood diseases and the clinical effect of glucocorticoid[J]. J Clin Hepatol, 2021, 37(8): 1878-1882. DOI: 10.3969/j.issn.1001-5256.2021.08.025

慢性肝病合并自身免疫性血液系统疾病的临床特征及应用糖皮质激素治疗效果分析

DOI: 10.3969/j.issn.1001-5256.2021.08.025
基金项目: 

首都卫生发展科研专项项目 2018-1-2172

北京市科学技术委员会资助 Z191100006619033

详细信息
    通讯作者:

    王宪波, wangxianbo638@163.com

  • 中图分类号: R575

Clinical features of chronic liver disease with autoimmune blood diseases and the clinical effect of glucocorticoid

Funds: 

Capital's Funds for Health Improvement and Research 2018-1-2172

Funded by Beijing Science and Technology Committee Z191100006619033

  • 摘要:   目的  分析慢性肝病合并免疫性血液系统疾病的临床特征, 探究糖皮质激素的疗效。  方法  回顾性分析2008年1月—2019年12月北京地坛医院收治的17例慢性肝病合并免疫性血液病患者的临床资料, 根据血液病种类分为3组: 自身免疫性溶血性贫血(AIHA)组、免疫性血小板减少症(ITP)组、Evans综合征组。进行糖皮质激素治疗及肝病相关治疗后, 比较3组治疗前后临床资料及实验室检查指标。计量资料两组间比较采用Mann-Whitney U检验。  结果  17例慢性肝病患者中有15例非病毒性肝炎患者, 其中自身免疫性肝病9例(占52.9%)。17例患者血液系统疾病分布: AIHA患者6例, ITP患者8例, Evans综合征患者3例。其中13例患者进行糖皮质激素治疗, 达到完全缓解或部分缓解者共12例, 总有效率92.3%。ITP组TBil、DBil治疗后较治疗前显著下降[35.8(14.3~58.0)μmol/L vs 165.6(21.3~374.3)μmol/L, Z=-2.205, P=0.027;24.9(7.0~43.3)μmol/L vs 121.9(11.7~279.9)μmol/L, Z=-2.205, P=0.027];AIHA组血红蛋白治疗后较治疗前显著上升[94.0(65.0~99.3)g/L vs 62.2(42.3~80.5)g/L, Z=-2.242, P=0.025]。  结论  多种类型慢性肝病均可合并免疫性血液系统疾病, 其中自身免疫性肝病合并免疫性血液系统疾病的发病率较高; 糖皮质激素是慢性肝病合并免疫性血液系统疾病安全有效的治疗方法。

     

  • 表  1  患者一般情况、基础肝病及合并血液病种类、发病先后次序

    编号 年龄 性别 血液病种类 肝病类型 特殊诱因
    1 46 ITP AIH1) 异常子宫出血
    2 36 AIHA 不明原因肝硬化1) 药物(CCI-779)
    3 28 Evans综合征 狼疮性肝炎1)
    4 60 AIHA AIH1)
    5 66 ITP 不明原因肝硬化1)
    6 39 ITP1) AIH
    7 56 Evans综合征 PBC1)
    8 29 ITP1) AIH
    9 49 ITP PBC1)
    10 32 AIHA 酒精性肝硬化1)
    11 31 ITP 慢性乙型肝炎1)
    12 60 AIHA AIH1)
    13 61 Evans综合征 PBC1)
    14 35 ITP1) 药物性肝炎
    15 63 AIHA PBC1)
    16 63 AIHA 药物性肝炎1) 药物(特比萘芬)
    17 60 ITP 乙型肝炎肝硬化1)
      注: 1)首发疾病。
    下载: 导出CSV

    表  2  ITP、AIHA及Evans综合征患者治疗前后实验室指标比较

    变量 ITP (n=8) AIHA (n=6) Evans综合征(n=3)
    WBC(109/L)
      治疗前 5.2(3.4~7.4) 4.5(3.2~7.2) 5.5(4.7~6.4)
      治疗后 5.4(4.1~11.9) 3.8(3.6~11.9) 8.2(5.7~10.7)
      Z -0.630 -0.160 -0.218
      P 0.529 0.873 0.827
    HGB(g/L)
      治疗前 95.6(63.2~122.3) 62.2(42.3~80.5) 79.0(68.1~89.9)
      治疗后 97.0(60.5~143.0) 94.0(65.0~99.3) 79.1(75.2~83.0)
      Z -1.052 -2.242 -0.655
      P 0.293 0.025 0.513
    PLT(1012/L)
      治疗前 54.0(13.8~83.1) 91.1(48.8~280.0) 46.9(28.7~68.1)
      治疗后 56.3(25.1~125.0) 41.0(30.0~146.0) 45.7(10.2~76.7)
      Z -1.470 -0.320 -0.655
      P 0.141 0.749 0.513
    网织红细胞(%)
      治疗前 7.0(2.9~9.5) 13.7(12.6~15.8) 10.3(7.3~16.8)
      治疗后 5.8(1.5~7.8) 14.1(11.2~17.0)
      Z -1.944 -0.823
      P 0.052 0.410
    PT(s)
      治疗前 19.7(15.0~25.7) 16.4(11.5~24.9) 12.8(10.9~13.8)
      治疗后 14.7(11.1~21.6) 11.4(10.1~26.4) 13.5(10.2~16.7)
      Z -1.470 -0.548 -0.577
      P 0.141 0.584 0.564
    ALT(U/L)
      治疗前 361.7(9.4~677.5) 106.6(21.1~346.9) 69.2(28.4~92.0)
      治疗后 30.9(15.8~71.9) 22.0(16.7~82.5) 68.6(62.0~75.1)
      Z -0.315 -0.365 -1.732
      P 0.753 0.715 0.083
    AST (U/L)
      治疗前 263.7(28.6~663.1) 101.4(32.2~237.1) 188.2(63.9~256.1)
      治疗后 43.1(23.1~53.1) 43.4(19.4~58.6) 60.1(38.0~82.2)
      Z -1.365 -0.913 -0.577
      P 0.172 0.361 0.564
    TBil(μmol/L)
      治疗前 165.6(21.3~374.3) 164.0(87.4~277.8) 94.0(74.3~108.3)
      治疗后 35.8(14.3~58.0) 148.8(34.2~227.4) 101.5(75.3~127.8)
      Z -2.205 -0.730 -1.155
      P 0.027 0.465 0.248
    DBil(μmol/L)
      治疗前 121.9(11.7~279.9) 118.4(29.8~224.4) 56.4(30.2~81.5)
      治疗后 24.9(7.0~43.3) 94.4(23.8~148.9) 56.3(8.4~104.1)
      Z -2.205 -0.548 0.000
      P 0.027 0.584 1.000
    Alb(g/L)
      治疗前 29.6(25.4~32.5) 32.2(27.7~36.1) 30.3(26.6~35.1)
      治疗后 34.1(28.0~35.9) 33.7(29.5~46.2) 35.2(34.6~39.4)
      Z -1.944 -0.823 -1.155
      P 0.052 0.410 0.248
    肌酐(mmol/L)
      治疗前 63.0(47.7~82.2) 66.4(53.8~85.2) 49.7(42.8~55.0)
      治疗后 57.2(44.5~76.0) 61.4(59.8~77.6)
      Z -0.630 0.000
      P 0.529 1.000
      注: —, 未化验。
    下载: 导出CSV
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  • 收稿日期:  2021-03-04
  • 修回日期:  2021-05-14
  • 刊出日期:  2021-08-16
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