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自身免疫性肝炎与原发性胆汁性胆管炎临床特征比较
Clinical features of autoimmune hepatitis and primary biliary cholangitis: A comparative analysis
文章发布日期:2019年01月07日  来源:  作者:舒艳芸,潘晓莉,宋宇虎,等  点击次数:159次  下载次数:22次

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【摘要】:目的 比较自身免疫性肝炎(AIH)、原发性胆汁性胆管炎(PBC)临床特征,以利于两者的鉴别及早期诊断。方法 收集2010年1月-2018年2月华中科技大学同济医学院附属协和医院诊治的AIH患者(n=83)和PBC患者(n=108)临床资料,包括年龄、性别、血清生化、免疫学指标及肝脏病理学检查结果,比较AIH与PBC的不同特征。正态分布计量资料两组间比较采用独立样本t检验;偏态分布计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher确切概率法。结果 纳入AIH及PBC患者均以女性为主,发病年龄高峰为40~60岁。二者临床表现无明显特异性,主要症状体征均为:乏力、腹胀、黄疸、纳差,其中AIH组纳差患者比例明显高于PBC组(25% vs 14%,χ2=6.52,P=0.011)。此外,AIH组肝硬化及合并风湿性疾病的比例亦明显高于PBC组(59.0% vs 40.7%,χ2=6.23,P=0.012;23.5% vs 15.7%,χ2=7.46,P=0.006)。AIH组PLT、ALP、GGT、IgM、红细胞沉降率(ESR)及补体C3水平均低于PBC组,PT、国际标准化比值(INR)及IgG水平均高于PBC组,差异均有统计学意义(P值均<0.05)。PBC患者抗线粒体M2型抗体(78.8% vs 14.8%)、抗核膜糖蛋白210抗体(46.4% vs 5.3%)、抗三联体抗体(抗3E抗体)(75.0% vs 31.6%)阳性率均高于AIH患者,差异均有统计学意义(χ2值分别为74.70、7.31、8.73,P值分别为<0.001、0.007、0.003)。肝组织学特点方面PBC主要以胆管改变(包括小胆管炎、胆管肉芽肿、胆管缺失、细胆管反应性增生)为主,AIH则以界面性肝炎为主(χ2值分别为31.00、5.88,P值分别为<0.001、0.015)。结论 AIH与PBC均好发于女性,临床表现无特异性,但入院时PLT、ALP、GGT、PT、INR、ESR、补体、免疫球蛋白水平,抗体的类型及肝脏病理学的差异均可用于二者鉴别,且抗3E抗体可辅助诊断PBC
【Abstract】:Objective To compare the clinical features of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), and to provide a reference for differentiation and early diagnosis of these two diseases. Methods A retrospective analysis was performed for the clinical data of 83 patients with AIH and 108 patients with PBC who were diagnosed and treated in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2010 to February 2018, including age, sex, serum biochemical parameters, immunological indices, and liver pathology. The clinical features of AIH and PBC were compared. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Results Most of the patients with AIH or PBC were female, with a peak age of onset of 40-60 years. There was no obvious specificity in the clinical features of AIH or PBC, with cardinal symptoms and signs of weakness, abdominal distension, jaundice, and poor appetite, and compared with the PBC group, the AIH group had a significantly higher proportion of patients with poor appetite (25% vs 14%, χ2=6.52, P=0.011). Compared with the PBC group, the AIH group also had significantly higher proportions of patients with liver cirrhosis (59.0% vs 40.7%, χ2=6.23, P=0.012) and rheumatic diseases (23.5% vs 15.7%, χ2=7.46, P=0.006). Compared with the PBC group, the AIH group had significantly lower platelet count (PLT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), immunoglobulin M, erythrocyte sedimentation rate (ESR), and complement C3 and significantly higher prothrombin time (PT), international normalized ratio (INR), and immunoglobulin G (all P<0.05). Compared with the AIH group, the PBC group had significantly higher positive rates of anti-mitochondrial antibody M2 (78.8% vs 14.8%, χ2=74.70, P<0.001), anti-gp210 antibody (46.4% vs 5.3%, χ2=7.31, P=0.007), and anti-BCOADC-E2 PDC-E2 OGDC-E2 (anti-3E-BPO) antibodies (75.0% vs 31.6%, χ2=8.73, P=0.003). As for liver histological features, PBC was characterized by bile duct injury, including small cholangitis, biliary granuloma, absence of bile duct, and reactive hyperplasia of bile capillaries, while AIH was characterized by interface hepatitis (χ2=31.00 and 5.88, P<0.001 and P=0.015). Conclusion AIH and PBC often occur in women and lack specific clinical manifestations. PLT, ALP, GGT, PT, INR, ESR, complement, and immunoglobulins on admission, type of serological antibodies, and liver pathological features can be used for the differential diagnosis of AIH and PBC, and anti-3E-BPO antibody can help with the diagnosis of PBC.
【关键字】:肝炎, 自身免疫性; 原发性胆汁性胆管炎; 疾病特征
【Key words】:hepatitis, autoimmune; primary biliary cholangitis; disease attributes
【引证本文】:SHU YY, PAN XL, SONG YH, et al. Clinical features of autoimmune hepatitis and primary biliary cholangitis: A comparative analysis[J]. J Clin Hepatol, 2019, 35(2): 354-358. (in Chinese)
舒艳芸,潘晓莉,宋宇虎,等. 自身免疫性肝炎与原发性胆汁性胆管炎临床特征比较[J]. 临床肝胆病杂志, 2019, 35(2): 354-358.

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