实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (4): 537-540.doi: 10.3969/j.issn.1672-5069.2019.04.022

• • 上一篇    下一篇

自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征:巴黎标准诊断中国患者灵敏度低

张骏飞, 许何明, 宋海燕, 董静, 潘劲劲, 陈照林, 徐军, 陈从新, 刘波   

  1. 230031 合肥市 解放军第901医院感染病科(张骏飞,许何明,宋海燕,董静,潘劲劲,陈照林,刘波);
    病理科(徐军);
    合肥京东方医院消化肝病科(陈从新)
  • 收稿日期:2019-01-13 出版日期:2019-07-10 发布日期:2019-07-19
  • 通讯作者: 刘波,E-mail:41000843@qq.com
  • 作者简介:张骏飞,男,38岁,医学博士

Autoimmune hepatitis-primary biliary cholangitis overlap syndrome:poor diagnostic sensitivity of Paris' criteria in Chinese patients

Zhang Junfei, Xu Heming, Song Haiyan, et al   

  1. Department of Infectious Diseases,901st Hospital,Joint Logistics Support Force of PLA,Hefei 230031,Anhui Provine,China
  • Received:2019-01-13 Online:2019-07-10 Published:2019-07-19

摘要: 目的 评估巴黎标准诊断中国自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征的正确性。方法 回顾性分析按巴黎标准诊断为自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征患者24例和原发性胆汁性肝硬化患者16例的临床资料,对14例部分原发性胆汁性胆管炎患者行肝穿刺检查。结果 16例自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征患者血清TBIL、ALT、GGT和IgG水平分别为(45.3±48.3)μmol/L、(236.8±71.8) U/L、(305.3±258.5) U/L和(25.3±9.9) g/l,与PBC患者【(53.4±57.8)μmol/L、(77.5±71.7) U/L、(389.2±324.3) U/L和(13.9±6.0) g/l,P<0.05】比,差异显著;两组血清ANA、AMA和AMA-M2阳性率无显著性差异(P>0.05),仅AIH/PBC OS患者血清SMA阳性7例(43.8%),与PBC组1例(4.2%)比较,差异有统计学意义(P<0.05);经肝组织学检查,5例原本诊断为PBC患者修正诊断为AIH/PBC OS,他们血清ALT水平分别为40.0U/L、82.8U/L、94.1 U/L、162.1 U/L和117.2 U/L,都远远低于5倍正常值上限。结论 采取巴黎标准诊断中国自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征患者往往因为血清指标水平低而漏诊,及时行肝穿刺检查还是很必要的。

关键词: 原发性胆汁性胆管炎, 自身免疫性-原发性胆汁性胆管炎重叠综合征, 巴黎标准, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of Paris criteria in Chinese patients with autoimmune hepatitis/primary biliary cholangitis overlap syndrome(AIH/PBC OS).Methods We retrospectively analyzed the clinical data of 24 patients with PBC and 16 with AIH/PBC OS diagnosed based on Paris' criteria,and 14 patients with PBC underwent liver biopsies.Results Serum bilirubin,ALT,GGT and IgG levels in 16 patients with AIH/PBC OS were(45.3±48.3) μmol/L,(236.8±71.8) U/L,(305.3±258.5) U/L and (25.3±9.9) g/l,significantly different as compared to【(53.4±57.8) μmol/L,(77.5±71.7) U/L,(389.2±324.3) U/L and (13.9±6.0) g/l,respectively,P<0.05】 in 24 patients with PBC; the prevalence of serum ANA,AMA and AMA-M2,but SMA(43.8% in patients with AIH/PBC OS vs. 4.2% in patient with PBC) between the two groups were not significantly different(P>0.05);we modified five patients' diagnosis from PBC to AIH/PBC OS as the liver histopathological evidence proved,while serum ALT levels in them were 40.0U/L,82.8U/L,94.1 U/L,162.1 U/L and 117.2 U/L,much lower than 5×ULN. Conclusion For the diagnosis of Chinese patients with AIH/PBC OS,we strongly recommend liver biopsy in order not to miss diagnosis.

Key words: Autoimmune hepatitis/Primary biliary cholangitis overlap syndrome, Primary biliary cholangitis, Paris' criteria, Diagnosis