自身免疫性肝病患者合并非酒精性脂肪性肝病的临床及病理特征
摘要
目的非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的发病率在世界范围内呈上升趋势。NAFLD可以发生在其他类型肝病患者中,包括自身免疫性肝炎(autoimmune hepatitis,AIH)及AIH重叠原发性胆汁性胆管炎(primary biliary cirrhosis,PBC)患者。NAFLD和它们有相似的生化学和组织学表现。本研究的目的是阐明AIH及AIH重叠PBC患者合并NAFLD的临床及病理特点。方法我们评估了2006年-2018年于上海交通大学医学院附属第九人民医院经肝脏穿刺确诊的AIH及AIH重叠PBC的患者。结果本研究共纳入67名受试者(12名男性,55名女性)。NAFLD的总患病率为20.9%。与不伴有NAFLD的AIH及AIH重叠PBC的患者相比,伴有NAFLD的患者具有以下特点:1、女性所占比例较低。2、年龄更大。3、碱性磷酸酶水平较低。4、两者炎症坏死分级及纤维化分期无明显差异。5、两者甘油三酯水平无明显差异。结论合并NAFLD的AIH及AIH重叠PBC患者与不合并NAFLD的患者存在不同的特点。了解这些差异对于正确诊断和治疗合并非酒精性脂肪性肝病的自身免疫性肝病患者至关重要。
引文
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[3]Adams LA,Lindor KD,Angulo P.The prevalence of autoatibodies and autoimmune hepatitis in patients with non-alcoholic fatty liver disease.Am J Gastroenterol,2004,99:1316-1320.
[4]Yatsuji S,Hashimoto E,Kaneda H,et al.Diagnosing autoimmune hepatitis in nonalcoholic fatty liver disease:is the International Autoimmune Hepatitis Group scoring system useful?J.Gastroenterol,2005,40:1130-1138.
[5]Takahashi A,Arinaga-Hino T,Ohira H,et al.Autoimmune hepatitisin Japan:trends in a nationwide survey. J Gastroenterol,2017,52:631-640.
[6]Watanabe S,Hashimoto E,Ikejima K,et al.Evidence-ba-sed clinical practice guidelines for nonalcoholic fattyliver disease/nonalcoholic steatohepatitis.Hepatol Re-s,2015,45:363-377.
[7]Eguchi Y,Hyogo H,Ono M,et al.Prevalence and assoc-iated metabolic factors of nonalcoholic fatty liver di-sease in the general population from 2009 to 2010 in J-apan:a multicenter large retrospective study.J Gastr-oenterol,2012,47:586-595.