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朱林林, 杨李桦, 谢其冰等. 自身免疫性肝炎合并干燥综合征的临床病理特点分析[J]. koko体育app 学报（医学版）, 2018, 49(2): 183-187.
引用本文: 朱林林, 杨李桦, 谢其冰等. 自己免疫系统性肝炎病症统一晾干综合性征的诊疗病检特殊性讲解[J]. 成都高中学报（医药学版）, 2018, 49(2): 183-187.
ZHU Lin-lin, YANG Li-hua, XIE Qi-bing. et al. Clinicopathological Analysis of Autoimmune Hepatitis with SjÖgren’s Syndrome[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(2): 183-187.
Citation: ZHU Lin-lin, YANG Li-hua, XIE Qi-bing. et al. Clinicopathological Analysis of Autoimmune Hepatitis with SjÖgren’s Syndrome[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(2): 183-187.

自身免疫性肝炎合并干燥综合征的临床病理特点分析

Clinicopathological Analysis of Autoimmune Hepatitis with SjÖgren’s Syndrome

  • 摘要: 目的探讨自身免疫性肝炎(AIH)合并干燥综合征(SS)的临床生化、免疫组织学特点。方法回顾性纳入2009年1月至2017年4月住院治疗的AIH患者共76例，其中AIH合并SS共40例，单纯AIH共36例，比较两组患者首诊信息、治疗费用、生化及免疫学指标、肝脏组织病理学表现。结果AIH合并SS组与单纯AIH组女性分别占97.5%、77.8%，首诊年龄<60岁的比例为70%、47.2%，两组中位病程分别为30月、9月，差异均有统计学意义（P＜0.05）。AIH合并SS组与单纯AIH组患者首诊原因为皮肤巩膜黄染（52.5% vs. 38.9%）、体检发现肝酶异常（17.5% vs. 44.4%）、口干眼干（15.0% vs. 2.8%）；首诊科室依次为消化内科（35.0% vs. 91.7%）、风湿免疫科（37.5% vs. 2.8%）、传染科（27.5% vs. 5.5%），差异均有统计学意义（P＜0.05）。两组的住院总费用、日均住院费用、住院日差异均无统计学意义（P＞0.05）。AIH合并SS组血清总胆红素、直接胆红素水平,IgM水平,抗线粒体抗体M2（AMA-M2）、抗肝可溶性抗原抗体（SLA）、抗Ro抗体（SSA）、抗La抗体（SSB）阳性率均高于单纯AIH组，白蛋白水平、补体3（C3）水平低于单纯AIH组，差异均有统计学意义（P＜0.05）。两组在肝脏组织病理学表现以及胆管损伤阳性率方面差异均无统计学意义（P＞0.05）。 结论中青年女性AIH患者以皮肤巩膜黄染为主要表现、存在多种高特异性自身抗体阳性时,需警惕合并SS。  
    Abstract: Objective To explore the biochemical-immune and pathological characteristics of autoimmune hepatitis（AIH） with Sj?gren’s syndrome （SS）. Methods A total of 76 cases of AIH patients were included from January 2009 to April 2017. Among them, there were 40 cases of AIH with SS and 36 cases without SS. The liver function, immunological index, histological features, length of first diagnosis and treatment costs were compared between the two groups. ResultsFor AIH+SS group and AIH group, the proportion of women were 97.5% and 77.8%, the proportion of the first diagnosis age less than 60 years were 70% and 47.2%, the median course of disease were 30 months and 9 months, all the difference were statistically significant (P<0.05). The chief complaints in AIH+SS group and AIH group were as follows: cutaneous or scleracterus (52.5% vs. 38.9%), abnormal transaminase (17.5% vs. 44.4%), dryness of mouth and eye (15.0% vs. 2.8%), all the difference were statistically significant (P<0.05). There were no statistically significant difference in hospitalization expenses, and length of stay between the two groups (P>0.05). The median level of total bilirubin (TBIL), direct bilirubin (DBIL) and immunoglobulin (Ig) M of AIH +SS group were higher than those of AIH group, the mean level of albumin (ALB) and complement 3 （C3） of AIH +SS group were lower than those of AIH group, and the positive rate of anti-mitochondrial antibody-M2 （AMA-M2）, anti-Ro antibody A (SSA), anti-La antibody (SSB) and anti-soluble liver antigen antibody (SLA) of AIH+SS group were higher than those of AIH group (P<0.05). There were no statistically significant difference in histological changes of hepatocytes and bile duct injury rate (P>0.05). Conclusion AIH patients in young and middle-aged women need to be vigilant with SS with main manifestation of skin sclera and high specific autoantibodies positive.  
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