论文部分内容阅读
目的探讨以黄疸为首发表现的自身免疫性肝炎(autoimmune hepatitis,AIH)患者的临床特点。方法选取2008年3月~2013年2月郸城县人民医院消化内科收治的41例以黄疸为首发表现的AIH患者作为观察组,选择同时期收治的57例非黄疸性AIH患者作为对照组。收集2组患者的一般情况、生化指标、免疫指标、自身抗体、组织病理学特点、治疗缓解率及缓解时间等的数据,进行统计学分析。结果 2组性别、年龄及是否伴有其他自身免疫性疾病的差异均无统计学意义。所有AIH患者均有肝功能异常,观察组ALT、AST、ALP、GGT、TBil均高于对照组,差异有统计学意义(P<0.05)。2组患者3种血清免疫球蛋白含量差异无统计学意义。2组患者各种自身抗体阳性率差异无统计学意义。观察组肝小叶中央区坏死程度及胆管反应均比对照组严重,纤维化程度深。经免疫抑制剂治疗后,观察组缓解32例,缓解率为78.05%;对照组缓解53例,缓解率为92.98%。2组缓解率差异有统计学意义(P<0.05)。观察组平均缓解时间为(27.32±8.74)个月,对照组平均缓解时间为(6.89±2.42)个月,差异有统计学意义(P<0.05)。结论以黄疸为首发表现的AIH肝功能损伤更严重,组织病理学表现差,免疫抑制剂缓解率较低,缓解时间较长,早诊断及恰当的治疗方法对其具有重要意义。
Objective To investigate the clinical features of autoimmune hepatitis (AIH) with jaundice as the first manifestation. Methods From March 2008 to February 2013, 41 cases of AIH with jaundice as the first manifestation in 41 patients admitted to Department of Gastroenterology, Dancheng People’s Hospital were selected as the observation group and 57 non-jaundiced AIH patients were selected as the control group. The general situation, biochemical indexes, immune indexes, autoantibodies, histopathological characteristics, treatment response rate and the time of remission of the two groups of patients were collected for statistical analysis. Results There were no significant differences in gender, age and other autoimmune diseases between the two groups. All AIH patients had liver dysfunction. The ALT, AST, ALP, GGT and TBil in the observation group were higher than those in the control group, with significant difference (P <0.05). There was no significant difference in the immunoglobulin content between the three groups in the two groups. There was no significant difference in the positive rates of various autoantibodies between the two groups. Observation group, the central area of hepatic lobule necrosis and bile duct response than the control group, a serious degree of fibrosis. After immunosuppressive therapy, the observation group remission in 32 cases, the remission rate was 78.05%; control group 53 patients relieved, the remission rate was 92.98%. There was significant difference in remission rate between the two groups (P <0.05). The average remission time in observation group was (27.32 ± 8.74) months, and the average remission time in control group was (6.89 ± 2.42) months, the difference was statistically significant (P <0.05). Conclusions The hepatic injury induced by jaundice in AIH is more serious. The pathological manifestations of AIH are poor. The immunosuppressive agents have a lower response rate and a longer response time. Early diagnosis and proper treatment are of great significance to them.