血清IgG低水平和转氨酶正常的AIH患者临床和肝组织病理学特征分析*

doi:10.3969/j.issn.1672-5069.2023.02.018

实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (2): 222-225.doi: 10.3969/j.issn.1672-5069.2023.02.018

血清IgG低水平和转氨酶正常的AIH患者临床和肝组织病理学特征分析^*

窦婧, 徐强, 王转国, 王宏峰, 乐永红, 王晓波, 付强, 宁忠慧, 胡西百合提, 倪卡, 敬进华, 余虹, 郭峰, 王晓忠

830099 乌鲁木齐市新疆医科大学第四临床医学院(窦婧,敬进华,余虹);附属中医医院(徐强,王转国,王宏峰,乐永红,王晓波,付强,宁忠慧,胡西百合提,倪卡,郭峰,王晓忠)

收稿日期:2022-08-11 出版日期:2023-03-10 发布日期:2023-03-21
通讯作者: 王晓忠,E-mail:wxz125@sina.com
作者简介:窦婧,女,29岁,博士研究生。主要从事中西医结合肝病诊断与治疗学研究。E-mail:1281413034@qq.com
基金资助:
^*国家自然科学基金资助项目(编号:81760832);新疆维吾尔自治区自然科学基金资助项目(编号:2022D01C173)

Clinical and liver histopathological features of patients with autoimmune hepatitis with low serum IgG and normal alanine aminotransferase levels

Dou Jing, Xu Qiang, Wang Zhuanguo, et al.

Fourth Clinical Medical College, Xinjiang Medical University, 830099 Urumqi, Xinjiang Uygur Autonomous Region, China

Received:2022-08-11 Online:2023-03-10 Published:2023-03-21

摘要/Abstract

摘要： 目的分析血清转氨酶正常和免疫球蛋白G(IgG)低水平的自身免疫性肝炎(AIH)患者临床和肝组织病理学特点。方法 2015年1月～2021年12月新疆医科大学附属中医医院收治的AIH患者61例,采集人口学、病史、血液指标、血清肝功能、免疫球蛋白G(IgG)、抗核抗体(ANA)和肝穿组织病理学资料。结果血清转氨酶正常组与升高组血清碱性磷酸酶(ALP)水平分别为93.7(71.0,161.0)U/L和193.6(41.0,320.4)U/L、谷氨酰转肽酶(GGT)水平分别为27.9(18.3,104.2)U/L和158.8(62.2,293.2)U/L、总胆红素(TBIL)分别为18.7(12.8,26.0)μmol/L和28.4(16.5,45.9)μmol/L、天冬氨酸氨基转移酶和血小板计数指数(APRI)分别为0.5(0.3,1.7)和3.1(1.1,5.1)、GGT/血小板(PLT)比值分别为0.2(0.1,1.4)和0.8(0.4,1.9),差异具有统计学意义(P＜0.01);两组肝组织炎症分级＞G2分别占45.0%和56.1%,纤维化分期＞S2分别占55.0%和41.5%、界面炎分别占90.0%和100.0%、浆细胞浸润分别占80.0%和90.2%、玫瑰花环样改变分别占25.0%和19.5%,差异无统计学意义(P＞0.05);血清IgG低水平(≤1.1 ULN)与IgG高水平(＞1.1 ULN)组肝组织病理学改变差异无统计学意义(P＞0.05);血清转氨酶正常且IgG低水平组与转氨酶升高且IgG高水平组血清ALP、GGT、TBIL、APRI和GGT/PLT比值差异有统计学意义(P＜0.01),而肝组织病理学改变差异无统计学意义(P＞0.05)。结论单纯使用血清学指标无法准确地反映AIH患者疾病的严重程度。对于血清IgG和转氨酶低水平的AIH患者也应进行肝组织学活检,才能准确地判断病情。

关键词: 自身免疫性肝炎, 丙氨酸氨基转移酶, 免疫球蛋白G, 肝组织病理学

Abstract: Objective The aim of this study was to analyze the clinical and liver histopathological features of patients with autoimmune hepatitis (AIH) with serum normal alanine aminotransferase (ALT) and low immunoglobulin G (IgG) levels. Methods 61 patients with AIH were admitted to Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University between January 2015 and December 2021, and the clinical and liver biopsy materials were retrospectively collected, including demographic information, medical history, blood routine, liver function tests, immunoglobulin G(IgG), antinuclear antibody (ANA). Results Serum alkaline phosphatase (ALP) levels were 93.7(71.0, 161.0)U/L and 193.6(41.0, 320.4)U/L, GGT levels were 27.9(18.3, 104.2)U/L and 158.8(62.2, 293.2)U/L, total serum bilirubin levels were 18.7(12.8, 26.0)μmol/L and 28.4(16.5, 45.9)μmol/L, aspartate aminotransferase-to-platelet ratio index (APRI) were 0.5(0.3, 1.7) and 3.1(1.1, 5.1), GGT/platelet ratio were 0.2(0.1, 1.4) and 0.8(0.4, 1.9), significantly different between patients with normal and elevated serum ALT levels(P＜0.01); the percentages of histological activity index greater than G2 were 45.0% and 56.1%, liver fibrosis greater than S2 were 55.0% and 41.5%, interfacial inflammation accounted for 90.0% and 100.0%, plasma cell infiltration accounted for 80.0% and 90.2%, and rose-rosette changes accounted for 25.0% and 19.5%, not significantly different between the two groups (P＞0.05); there was no significant difference as respect to liver histopathological changes between patients with low serum IgG level and those with elevated serum IgG level (P＞0.05); there were significant differences respect to serum ALP, GGT, TBIL, APRI and GGT/PLT ratio (P＜0.01)between patients with normal serum ALT and low IgG level and those with elevated serum ALT and IgG levels, while there was no significant difference as respect to liver histopathological changes between them (P＞0.05). Conclusions Serum biochemical and serological indexes could not accurately reflect the disease severity in patients with AIH, and we recommend liver biopsy in AIH patients with low serum IgG and normal ALT.

Key words: Autoimmune hepatitis, Alanine aminotransferase, Immunoglobulin G, Liver histopathology

窦婧, 徐强, 王转国, 王宏峰, 乐永红, 王晓波, 付强, 宁忠慧, 胡西百合提, 倪卡, 敬进华, 余虹, 郭峰, 王晓忠. 血清IgG低水平和转氨酶正常的AIH患者临床和肝组织病理学特征分析^*[J]. 实用肝脏病杂志, 2023, 26(2): 222-225.

Dou Jing, Xu Qiang, Wang Zhuanguo, et al.. Clinical and liver histopathological features of patients with autoimmune hepatitis with low serum IgG and normal alanine aminotransferase levels[J]. Journal of Practical Hepatology, 2023, 26(2): 222-225.

参考文献

[1] Covelli C, Sacchi D, Sarcognato S, et al. Pathology of autoimmune hepatitis. Pathologica, 2021, 113(3): 185-193.
[2] Alvarez F, Berg PA, Bianchi FB, et al. International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol, 1999, 31(5): 929-938.
[3] Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology, 2008, 48(1): 169-176.
[4] 中华医学会肝病学分会. 自身免疫性肝炎诊断和治疗指南(2021年). 中华内科杂志, 2021, 60(12): 1038-1049.
[5] Komori A. Recent updates on the management of autoimmune hepatitis. Clin Mol Hepatol, 2021, 27(1): 58-69.
[6] Harada K, Hiep NC, Ohira H. Challenges and difficulties in pathological diagnosis of autoimmune hepatitis. Hepatol Res, 2017, 47(10): 963-971.
[7] Laschtowitz A, Zachou K, Lygoura V, et al. Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. JHEP Rep, 2021, 3(4): 100321-100321.
[8] Lohse AW, Chazouillères O, Dalekos G, et al. EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol, 2015, 63(4): 971-1004.
[9] Hartl J, Ehlken H, Sebode M, et al. Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis. J Hepatol, 2018, 68(4): 754-763.
[10] Li Y, Yan L, Wang R, et al. Serum immunoglobulin G levels predict biochemical and histological remission of autoimmune hepatitis type 1: a single-center experience and literature review. Clin Rev Allergy Immunol, 2022, 62(2): 292-300.
[11] 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. 肝纤维化诊断及治疗共识(2019年). 实用肝脏病杂志, 2019, 22(6): 793-803.
[12] Mack CL, Adams D, Assis DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 practice guidance and guidelines from the American association for the study of liver diseases. Hepatology, 2020, 72(2): 671-722.
[13] Wang G, Tanaka A, Zhao H, et al. The Asian Pacific association for the study of the liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis. Hepatol Int, 2021, 15(2): 223-257.
[14] Hartl J, Miquel R, Zachou K, et al. Features and outcome of AIH patients without elevation of IgG. JHEP Rep, 2020, 2(3): 100094-100094.
[15] Lohse AW, Sebode M, Bhathal PS, et al. Consensus recommendations for histological criteria of autoimmune hepatitis from the international AIH pathology group: results of a workshop on AIH histology hosted by the European reference network on hepatological diseases and the European society of pathology. Liver Int, 2022, 42(5): 1058-1069.
[16] 苗琪, 陈晓宇. 自身免疫性肝炎的肝组织病理学诊断. 临床肝胆病杂志, 2020, 36(04): 728-730.
[17] Sucher E, Sucher R, Gradistanac T, et al. Autoimmune hepatitis-immunologically triggered liver pathogenesis-diagnostic and therapeutic strategies. J Immunol Res, 2019, 2019(2019): 9437043.
[18] 龙梅, 王丽旻, 朱莉, 等. 自身免疫性肝炎患者临床和肝组织病理学特征. 实用肝脏病杂志, 2020, 23(1): 142-143.
[19] Tasneem AA, Luck NH. Autoimmune hepatitis: clinical characteristics and predictors of biochemical response to treatment. J Transl Int Med, 2020, 8(2): 106-111.
[20] Tiniakos DG, Brain JG, Bury YA. Role of histopathology in autoimmune hepatitis. Dig Dis, 2015, 33(Suppl 2): 53-64.

血清IgG低水平和转氨酶正常的AIH患者临床和肝组织病理学特征分析^*

Clinical and liver histopathological features of patients with autoimmune hepatitis with low serum IgG and normal alanine aminotransferase levels

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