82例急性自身免疫性肝炎临床、生化和组织学特征

摘要/Abstract

摘要： 目的分析急性自身免疫性肝炎(AAIH)患者的临床、生化和组织学特征。方法 2010年1月至2022年10月诊治并完成肝活检的AAIH患者82例。根据INR和肝性脑病状态,急性非重症、急性重症及暴发型AAIH患者分别为52例、21例及9例,比较各组患者临床病理资料,采用多因素logistic回归分析AAIH患者病情状态的影响因素。结果急性非重症AAIH患者TBil、凝血酶原活动度为101.6(28.0,202.5)μmol/L、74(55,87)%,与急性重症[211.6(150.9,381.3)μmol/L、42(33,58)%]及暴发型[352.2(215.1,492.4)μmol/L、31(22,50)%]AAIH患者比,差异有统计学意义(P<0.05)。急性非重症、急性重症及暴发型AAIH患者类固醇使用分别为49例(94.2%)、13例(61.9%)及5例,差异有统计学意义(P<0.05)。多因素logistic回归分析提示TBil(OR=2.03, 95%CI: 1.11~3.72)、凝血酶原活动度(OR=4.27, 95%CI: 1.22~14.92)及类固醇使用(OR=1.60, 95%CI: 1.12~2.27)是影响AAIH患者病情状态的独立预测因素(P<0.05)。急性非重症、急性重症及暴发型AAIH患者胆汁淤积分别为15例(28.8%)、10例(47.6%)及8例,差异有统计学意义(P<0.05);急性非重症AAIH中轻、中及重度小叶中央坏死为26例(50.0%)、12例(23.1%)及14例(26.9%),与急性重症[4例(19.0%)、2例(9.5%)及15例(71.4%)]及暴发型(3例、0及6例)AAIH患者比,差异有统计学意义(P<0.05)。结论与慢性表现AIH相比,AAIH患者在临床表现、实验室资料及组织学结果中存在着差异。暴发性肝炎、胆汁淤积、TBil和凝血酶原活动度是AAIH患者预后的危险因素。

关键词: 自身免疫性肝炎, 凝血酶原活动度, 胆汁淤积, Logistic回归分析

Abstract: Objective To analyze the clinical, biochemical and histological characteristics of patients with acute autoimmune hepatitis (AAIH). Methods Between January 2010 and October 2022, 82 patients with AAIH who underwent liver biopsy were reviewed, including 13 males and 61 females, aged (53.2±8.7) years. All cases met the diagnostic criteria for AIH and AAIH. Patients were classified into three groups based on their International Normalized Ratio(INR) status and the presence of hepatic encephalopathy: acute non-severe cases(INR<1.5), acute severe cases(INR>1/5, with no hepatic encephalopathy), and fulminate cases(acute severe cases where hepatic encephalopathy occurred within 26 weeks post-jaundice onset). The clinical and pathological data of each group were compared, and the influencing factors of AAIH patients' conditions were discussed by multivariate Logistic regression analysis. Results There were 52 cases of non-severe, 21 cases of acute severe and 9 cases of fulminant AAIH, respectively. The TBil level and prothrombin activity in non-severe cases were 101.6 (28.0, 202.5) μmol/L, 74 (55, 87) %, respectively. Compared with those in acute severe cases [211.6 (150.9, 381.3) μmol/L, 42 (33, 58) %] and fulminant cases [352.2 (215.1, 492.4) μmol/L, 31 (22, 50) %], the differences were statistically significant (P<0.05). There were 49 cases (94.2%), 13 cases (61.9%) and 5 cases (55.5%) of acute non-severe, acute severe and fulminant AAIH patients, respectively, and the difference was statistically significant (P<0.05). Taking the conditions of AAIH patients (assignment 0= acute non-severe, 1= acute severe and fulminant) as dependent variables, and TBil, prothrombin activity and steroid use (assignment 0= used, 1= unused) as independent variables, multivariate Logistic regression analysis showed that TBil, prothrombin activity and steroid use were independent predictors of AAIH patients' condition (P<0.05). There were 15 cases (28.8%), 10 cases (47.6%) and 8 cases (88.9%) of acute non-severe, acute severe and fulminant AAIH patients with cholestasis, and the difference was statistically significant (P<0.05). There were 26 cases (50.0%), 12 cases (23.1%) and 14 cases (26.9%) of non-severe mild, moderate and severe central lobular necrosis, compared with acute severe [4 cases (19.0%), 2 cases (9.5%) and 15 cases (71.4%)] and fulminant [3 cases (33.3%), 0 (0) and 6 cases (66.7%)], and the difference was statistically significant (P<0.05). Conclusion Compared with chronic AIH, AAIH patients have differences in clinical manifestations, laboratory data and histological results. Fulminant hepatitis, cholestasis, TBil and prothrombin activity are risk factors for the prognosis of AAIH patients.

Key words: Autoimmune hepatitis, Prothrombin activity, Cholestasis, Logistic regression analysis

王会迟, 田璐, 郑毅, 赵鹏, 董海苓, 边毓尧. 82例急性自身免疫性肝炎临床、生化和组织学特征[J]. 肝脏, 2023, 28(6): 716-719.

WANG Hui-chi, TIAN Lu, ZHENG Yi, ZHAO Peng, DONG Hai-ling, BIAN Yu-yao. Clinical, biochemical and histological features of 82 cases of acute autoimmune hepatitis[J]. Chinese Hepatolgy, 2023, 28(6): 716-719.

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