论文部分内容阅读
目的分析自身免疫性肝病临床、病理特点，探讨早期诊断、治疗方法。方法１９９６—１９９８年收治６２例自身免疫性肝病，比较原发性胆汁性肝硬化（ＰＢＣ）、自身免疫性肝炎（ＡＩＨ）的临床症状、体征、生物化学指标及病理特征。结果自身免疫性肝病中ＰＢＣ占５９．６８％， ＡＩＨ ４０．３２％。自身免疫性肝病中８３．８％是中老年女性，男女之比１∶１０，而ＡＩＨ １∶５，发病年龄平均３５岁。ＰＢＣ中血循环自身免疫抗体阳性率８５．２９％，ＡＩＨ ７８．９５％。在阳性病例中 ＡＭＡ， ＡＭＡ－Ｍ２阳性率 １００％， ＡＮＡ阳性率 ８０％，血清免疫球蛋白异常， ＰＢＣ ＩｇＭ增高占８０％， ＡＩＨＩｇＧ增高占８２．２５％， Ｐ值＜０．０５和Ｐ值＜ ０．０２５。 ＰＢＣ肝脏活组织病理显示，胆管炎和胆管增生、炎症、损伤或三者共存的特征。ＡＩＨ显示门静脉区炎症、淋巴细胞、单核细胞、浆细胞浸润、坏死、纤维化。结论ＰＢＣ和ＡＩＨ是自身免疫性肝病临床上两个常见类型，其中ＡＩＨ以Ⅰ型为主；而血中ＡＭＡ－Ｍ２是ＰＢＣ特征抗体，强的松龙治疗效果ＡＩＨ优于ＰＢＣ。
Objective To analyze the clinical and pathological features of autoimmune liver disease and to explore the methods of early diagnosis and treatment. Methods From 1996 to 1998, 62 cases of autoimmune liver disease were treated. The clinical symptoms, signs, biochemical indexes and pathological features of primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) were compared. Results PBC accounted for 59.68% and AIH 40.32% in autoimmune liver disease. 83.8% of autoimmune liver disease is middle-aged and elderly women, the ratio of male to female 1:10, and AIH 1: 5, the average age of onset of 35 years old. The positive rate of circulating autoimmune antibodies in PBC was 85.29% and AIH was 78.95%. In the positive cases, AMA, AMA-M2 positive rate of 100%, ANA-positive rate of 80%, serum immunoglobulin abnormalities, PBC IgM increased 80%, AIHIgG increased 82.25%, P value <0.05 and P value <0.025. Pathology of PBC liver biopsy shows characteristics of cholangitis and biliary hyperplasia, inflammation, injury or coexistence of the three. AIH shows portal vein inflammation, lymphocytes, monocytes, plasma cell infiltration, necrosis, fibrosis. Conclusions PBC and AIH are two common clinical types of autoimmune liver disease, of which AIH predominates in type I, while AMA-M2 in blood is a characteristic antibody of PBC. Prednisolone treatment is superior to PBC in the treatment of AIH.