181例胆汁淤积型自身免疫性肝炎患者的临床特点分析

吕飒; 游绍莉; 田华; 宋芳娇; 刘婉姝; 王海波; 李晨; 刘利敏; 朱冰

doi:10.3969/j.issn.1001-5256.2017.08.024

181例胆汁淤积型自身免疫性肝炎患者的临床特点分析

DOI: 10.3969/j.issn.1001-5256.2017.08.024

解放军第三〇二医院肝衰竭诊疗与研究中心

基金项目:

北京市科技计划课题资助项目(Z161100000516172)；

详细信息

中图分类号: R575.1
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出版历程
- 收稿日期: 2017-01-12
- 出版日期: 2017-08-20

Clinical features of 181 patients with cholestatic autoimmune hepatitis

Liver Failure Treatment and Research Center, 302 Hospital of PLA

Research funding:

摘要

摘要:
目的探讨胆汁淤积型自身免疫性肝炎（AIH）患者的临床特点及激素治疗转归情况。方法收集2014年1月-2015年12月于解放军第三〇二医院住院的AIH、自身免疫性肝炎肝硬化（AIH-LC）、自身免疫性肝炎肝衰竭（AIH-LF）患者,对符合纳入标准的胆汁淤积型AIH患者临床资料进行回顾性分析,并对激素治疗患者的好转率及未应用激素治疗的原因进行分析。正态分布的计量资料多组间比较采用单因素方差分析,非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ2检验。结果共纳入胆汁淤积型AIH患者181例,其中AIH组15例、AIH-LC组142例,AIH-LF组24例,男女比例1∶11.1,符合抗核抗体阳性和（或）抗平滑肌抗体阳性的1型AIH患者占96.7%（175/181）。胆汁淤积型AIH患者中以肝硬化所占比例最高（78.5%）。3组患者在年龄、Alb、PTA、ALT、AST、GGT、TBil水平比较差异均有统计学意义（F值分别为3.836、13.271、41.819;χ2值分别为29.153、22.759、8.826、26.942,...
- 肝炎,自身免疫性 /
- 胆汁淤积 /
- 回顾性研究
Abstract:
Objective To investigate the clinical features of patients with cholestatic autoimmune hepatitis ( AIH) and their prognosis after corticosteroid therapy. Methods The patients with AIH, autoimmune hepatitis-liver cirrhosis ( AIH-LC) , or autoimmune hepatitis-liver failure ( AIH-LF) who were hospitalized in 302 Hospital of PLA from January 2014 to December 2015 were enrolled, and a retrospective analysis was performed for the clinical data of the patients with cholestatic AIH who met the inclusion criteria. The improvement rate of patients receiving corticosteroid therapy and reasons why corticosteroid therapy was not applied were analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results A total of 181 patients with cholestatic AIH were enrolled, with 15 patients in AIH group, 142 in AIH-LC group, and 24 in AIH-LF group. The male/female ratio was 1 ∶ 11. 1. Type-1 AIH patients with positive anti-nuclear antibody and/or anti-smooth muscle antibody accounted for 96. 7% ( 175/181) . Most patients with cholestatic AIH had liver cirrhosis ( 78. 5%) . There were significant differences between the three groups in age, albumin, prothrombin time activity, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase and total bilirubin ( F = 3. 836, 13. 271, and 41. 819, χ2= 29. 153, 22. 759, 8. 826, and 26. 942, all P <0. 05) . The 181 patients with cholestatic AIH achieved an overall improvement rate of 36. 5%, and the AIH group had the highest improvement rate ( 66. 7%) . Of all patients, 35 ( 19. 3%) received corticosteroid therapy, and these patients had a significantly higher improvement rate than those who did not receive corticosteroid therapy ( 57. 1% vs 31. 5%, χ2= 8. 009, P = 0. 005) . Infection, ascites, and gastrointestinal bleeding were main reasons for the absence of corticosteroid therapy. Conclusion Cholestatic AIH is commonly seen in female patients, and most of patients with cholestatic AIH have liver cirrhosis or type-1 AIH. Corticosteroid therapy is an effective method, but its application is limited by infection, ascites, and gastrointestinal bleeding.
- hepatitis, autoimmune /
- cholestasis /
- retrospective studies

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参考文献(16)

[1]Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Gastroenterology, Chinese Medical Association;Chinese Society of Infectious Diseases, Chinese Medical Association.Consensus on the diagnosis and management of autoimmune hepatitis (2015) [J].J Clin Hepatol, 2016, 32 (1) :9-22. (in Chinese) 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会.自身免疫性肝炎诊断和治疗共识 (2015) [J].临床肝胆病杂志, 2016, 32 (1) :9-22.

[2]PANAYI V, FROUD OJ, VINE L, et al.The natural history of autoimmune hepatitis presenting with jaundice[J].Eur J Gastroenterol Hepatol, 2014, 26 (6) :640-645.

[3]YEOMAN AD, WESTBROOK RH, ZEN Y, et al.Early predictors of corticosteroid treatment failure in icteric presentations of autoimmune hepatitis[J].Hepatology, 2011, 53 (3) :926-934.

[4]HENNES EM, ZENIYA M, CZAJA AJ, et al.Simplified criteria for the diagnosis of autoimmune hepatitis[J].Hepatology, 2008, 48 (1) :169-176.

[5] Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, CMA;Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, CMA.Guideline for diagnosis and treatment of liver failure (2012 version) [J].Chin J Clin Infect Dis, 2012, 5 (6) :321-327. (in Chinese) 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南 (2012年版) [J].中华临床感染病杂志, 2012, 5 (6) :321-327.

[6]FELD JJ, DINH H, ARENOVICH T, et al.Autoimmune hepatitis:effect of symptoms and cirrhosis on natural history and outcome[J].Hepatology, 2005, 42 (1) :53-62.

[7]CZAJA AJ, dos SANTOS RM, PORTO A, et al.Immune phenotype of chronic liver disease[J].Dig Dis Sci, 1998, 43 (9) :2149-2155.

[8]CZAJA AJ.Review article:the prevention and reversal of hepatic fibrosis in autoimmune hepatitis[J].Aliment Pharmacol Ther, 2014, 39 (4) :385-406.

[9]CZAJA AJ.Rapidity of treatment response and outcome in type 1 autoimmune hepatitis[J].J Hepatol, 2009, 5 (1) :161-167.

[10] European Association for the Study of the Liver.EASL clinical practice guidelines:autoimmune hepatitis[J].J Hepatol, 2015, 63 (4) :971-1004.

[11]ZHU B, YOU SL, WAN ZH, et al.Clinical characteristics and corticosteroid therapy in patients with autoimmune-hepatitis-induced liver failure[J].World J Gastroenterol, 2014, 20 (23) :7473-7479.

[12]WIEGAND J, SCHLER A, KANZLER S, et al.Budesonide in previously untreated autoimmune hepatitis[J].Liver Int, 2005, 25 (5) :927-934.

[13]WOLF DC, BOJITO L, FACCIUTO M, et al.Mycophenolate mofetil for autoimmune hepatitis:a single practice experience[J].Dig Dis Sci, 2009, 54 (11) :2519-2522.

[14]CHATUR N, RAMJI A, BAIN VG, et al.Transplant immunosuppressive agents in non-transplant chronic autoimmune hepatitis:the Canadian association for the study of liver (CASL) experience with mycophenolate mofetil and tacrolimus[J].Liver Int, 2005, 25 (4) :723-727.

[15]LARSEN FS, VAINER B, EEFSEN M, et al.Low-dose tacrolimus ameliorates liver inflammation and fibrosis in steroid refractory autoimmune hepatitis[J].World J Gastroenterol, 2007, 13 (23) :3232-3236.

[16]WEILER-NORMANN C, SCHRAMM C, QUAAS A, et al.Infliximab as a rescue treatment in difficult-to-treat autoimmune hepatitis[J].J Hepatol, 2013, 58 (3) :529-534.

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