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本文报告2例自身免疫性慢性肝病妇女发生原发性肝细胞癌。例1女性,34岁,1969年发现肝炎。血清胆红素4.4mg/100ml,天冬氨酸转氨酶180IU/L,丙种球蛋白24g/L。红斑狼疮细胞检查强阳性,抗核抗体和抗平滑肌抗体滴度>1/40,HBsAg 阴性,诊断为“狼疮样”慢性活动性肝病,用强的松龙疗效满意。1973年4月肝活检,见肝硬变伴中度片状坏死和门管区慢性炎症细胞浸润。1978年第4次复发后,每日要用强的松龙15mg 和硫唑嘌呤100mg 作维持治疗。1980年3月再次出现黄疸并发展为肝性脑病,抗平滑肌抗体和抗核抗体仍阳性(1/40),双股 DNA 抗体阳性,血清甲胎蛋白16,000IU/ml,诊断为原发性肝细胞癌。放射免疫法检测 HBsAg 和抗-HBs、抗-HBc、抗-HBe 均为阴性,从而排除了乙型肝炎病毒感染.患者因食管静脉大量出血迅速恶化死亡,尸检发现肝
This article reports 2 cases of autoimmune chronic liver disease in women with primary hepatocellular carcinoma. Example 1 Female, 34 years old, found hepatitis 1969. Serum bilirubin 4.4mg / 100ml, aspartate aminotransferase 180IU / L, gamma globulin 24g / L. Lupus erythematosus cells strongly positive examination, antinuclear antibody and anti-smooth muscle antibody titer> 1/40, HBsAg-negative, diagnosed as “lupus-like” chronic active liver disease, with satisfactory results of prednisolone. April 1973 Liver biopsy, cirrhosis with moderate necrosis and tubular necrosis of chronic inflammatory cell infiltration. After the fourth relapse in 1978, daily use of prednisolone 15mg and azathioprine 100mg for maintenance treatment. Again in March 1980 jaundice and development of hepatic encephalopathy, anti-smooth muscle antibodies and antinuclear antibodies still positive (1/40), double-stranded DNA antibody positive, serum alpha-fetoprotein 16,000IU / ml, diagnosed as primary liver Cell cancer. Radioimmunoassay detection of HBsAg and anti-HBs, anti-HBc, anti-HBe are negative, thus ruled out the hepatitis B virus infection in patients with esophageal venous rapid deterioration of a large number of deaths, necropsy found that liver