急性表现的自身免疫性肝炎的临床和病理特征分析

摘要/Abstract

摘要： 目的分析急性表现的自身免疫性肝炎的临床和病理特征。方法纳入2012年1月—2022年6月期间广西右江民族医学院附属梧州医院收治并接受肝活检的74例AIH患者,其中男性13例,女性61例,年龄(53.2±8.7)岁。AIH诊断符合要求,其中急性AIH需满足以下至少一个条件:总胆红素(TBil)≥85.5 μmol/L;转氨酶水平(ALT/AST)≥10×正常值上限。比较基线资料、实验室指标及病理学表现。结果 77例AIH患者中急、慢性AIH分别为32例、45例。两组性别、年龄、IAIHG评分、肝外自身免疫性疾病及发病时间比较差异无统计学意义(P>0.05);临床表现中,急性AIH患者黄疸、厌食及尿黄比例显著高于慢性AIH患者(P<0.05)。急性AIH患者TBil、ALT、AST、PT、INR、IgG及ANA滴度阳性率>1∶100分别为83.4(47.8, 192.8)μmol/L、237(141, 352)U/L、292(168, 357)U/L、15.1(13.6, 16.5)s、1.3(1.1, 1.4)、30.2(21.4, 33.3)g/L及27例(84.4%),均显著高于慢性AIH患者[24.0(13.2, 47.8)μmol/L、44(23, 94)U/L、56(34, 97)U/L、12.8(11.7, 13.7)s、1.1(1.0, 1.1)、21.6(17.6, 24.3)g/L及23例(51.1%),P<0.05];急、慢性AIH患者Alb分别为(34.2±3.0)g/L、(40.2±3.1)g/L,差异具有统计学意义(P<0.05)。急性AIH的组织病理学为急性肝炎表现,急、慢性AIH患者炎症分级、小叶炎症、界面性肝炎、玫瑰花结、门静脉周围淋巴细胞、浆细胞、中性粒细胞、胆管损伤及小叶中性粒细胞等比较差异具有统计学意义(P<0.05),而两者肝纤维化分期比较差异无统计学意义(P>0.05)。结论急性AIH以急性肝炎表现为主,临床表现、血清学检查可以初步区分急慢性AIH。组织病理学中,除了炎症分级高、界面性肝炎、玫瑰花结以及门静脉周围炎性细胞外,急性AIH还易出现胆管损伤,应重视长期随访。

关键词: 自身免疫性肝炎, 炎症分级, 肝纤维化, 胆管损伤

Abstract: Objective To analyze clinical and pathological features of acute autoimmune hepatitis.Methods 74 patients with AIH who were hospitalized and underwent liver biopsy from January 2012 to June 2022 in Jiangbin Hospital of Guangxi were enrolled. The patients included 13 males and 61 females, with a mean age of 53.2±8.7 years. The diagnosis of acute AIH needed to meet at least one of the following conditions: total bilirubin (TBil) ≥ 85.5 μmol/L; transaminase level (ALT/AST) ≥ 10 × the upper limit of normal value. The baseline data, laboratory indexes and pathological manifestations were analyzed.Results There were 32 cases of acute AIH and 45 cases of chronic AIH in 77 patients. There were no significant differences in sex, age, IAIHG score, extrahepatic autoimmune diseases and onset time between the two groups (P>0.05). However, patients with acute AIH had a significantly higher proportion of jaundice, anorexia, and yellow urine compared to patients with chronic AIH (P<0.05). The positive rates of TBil, ALT, AST, PT, INR, IgG and ANA titers in patients with acute AIH>1∶100 were 83.4 (47.8, 192.8) μmol/L, 237 (141, 352) U/L, 292 (168, 357) U/L, 15.1 (13.6, 16.5) s, 1.3 (1.1, 1.4), 30.2 (21.4, 33.3) g/L and 27 cases (84.4%), respectively, which were significantly higher than those in patients with chronic AIH [24.0 (13.2, 47.8) μmol/L, 44 (23, 94) U/L, 56 (34, 97) U/L, 12.8(11.7, 13.7) s, 1.1 (1.0, 1.1), 21.6 (17.6, 24.3) g/L and 23 cases (51.1%), P<0.05]. The Alb of patients with acute and chronic AIH was (34.2±3.0) g/L and (40.2±3.1) g/L, and the difference was statistically significant (P<0.05). Acute AIH was mainly characterized by acute hepatitis in histopathology. There were significant differences in inflammation grade, lobular inflammation, interfacial hepatitis, rosette, lymphocytes around portal vein, plasma cells, neutrophils, bile duct injury and lobular neutrophils between acute and chronic AIH patients (P<0.05), but there was no significant difference in liver fibrosis stage between them (P>0.05).Conclusion Acute AIH is mainly characterized by acute hepatitis. Clinical manifestations and serological examination can preliminarily distinguish acute AIH from chronic AIH. In histopathology, besides high inflammatory grade, interfacial hepatitis, rosette and inflammatory cells around the portal vein, acute AIH is prone to bile duct injury. Therefore, long-term follow-up should be paid attention to.

Key words: Autoimmune hepatitis, Inflammation grading, Hepatic fibrosis, Bile duct injury

郑慕阳, 胡海, 范显文. 急性表现的自身免疫性肝炎的临床和病理特征分析[J]. 肝脏, 2023, 28(8): 953-956.

ZHENG Mu-yang, HU Hai, FAN Xian-wen. Analysis of clinical and pathological features of acute autoimmune hepatitis[J]. Chinese Hepatolgy, 2023, 28(8): 953-956.

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