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目的探讨自身免疫性肝炎(AIH)与病毒性肝炎的临床病例特点,提高自身免疫性肝炎的早期诊断的准确率,从而减少漏诊和误诊。方法选取68例AIH患者,其中急性发病32例,慢性发病36例;再选取同期收治的70例病毒性肝炎患者,其中35例慢性乙型肝炎患者,35例急性病毒性肝炎患者,作为对照。结果在免疫学以及生化检查时,AIH患者的Y球蛋白、IgM、IgG、ALP、GGT、AST/ALT的水平明显比慢性乙型肝炎和急性病毒性肝炎患者高,且AIH的慢性发病患者的Y球蛋白水平明显比急性发病患者高(P<0.05);在肝组织的病理表现上,AIH患者于慢性病毒性肝炎患者在肝组织的病理表现上比较类似,但是与急性病毒性肝炎患者容易区别。结论 AIH患者的Y球蛋白、IgM、IgG、ALP、GGT、AST/ALT的水平明显比病毒性肝炎患者高,AIH患者在肝组织的病理表现较多样,最常见的主要是以碎屑样坏死,同时伴有大量淋巴细胞浸润以及桥接坏死。肝组织学检查对于AIH的早期诊断具有非常重要的意义。
Objective To explore the clinical features of autoimmune hepatitis (AIH) and viral hepatitis and to improve the accuracy of early diagnosis of autoimmune hepatitis so as to reduce the missed diagnosis and misdiagnosis. Methods Sixty-eight AIH patients were selected, of which 32 were acute and 36 were chronic. Another 70 patients with viral hepatitis were enrolled in this study. Among them 35 patients with chronic hepatitis B and 35 patients with acute viral hepatitis served as controls. Results The levels of Y globulin, IgM, IgG, ALP, GGT and AST / ALT in patients with AIH were significantly higher than those in patients with chronic hepatitis B and acute viral hepatitis during immunological and biochemical examinations, and those with chronic onset of AIH Y globulin levels were significantly higher than those of patients with acute onset (P <0.05). Pathological findings of liver tissues were similar in patients with chronic viral hepatitis but with acute viral hepatitis . Conclusion The levels of Y globulin, IgM, IgG, ALP, GGT and AST / ALT in patients with AIH are significantly higher than those in patients with viral hepatitis, and the pathological findings of AIH patients in liver tissues are more diverse. The most common is mainly detrusor necrosis , Accompanied by a large number of lymphocytic infiltration and bridging necrosis. Liver histology for the early diagnosis of AIH has a very important significance.