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目的分析儿童自身免疫性肝炎与药物性肝病的发病机制、临床特点和预后。方法2006年5月至2008年4月华中科技大学同济医学院附属同济医院收治儿童自身免疫性肝炎3例、药物性肝病5例,对其病因、临床表现、实验室检查、治疗方案和预后进行回顾性分析和总结,并复习相关文献进行临床比较。结果3例自身免疫性肝炎患儿病史6个月至3年、肝脾中至重度增大、血清IgG水平升高、自身抗体阳性、肝组织病理学检查示肝细胞水肿变性、间质及汇管区炎性细胞浸润、皮质激素治疗有效;5例药物性肝病患儿曾应用过相关药物、病史3~20d、4例肝脏轻至中度肿大、3例急性期天冬氨酸转移酶1000U/L以上、2例血清IgG水平升高、自身抗体阴性、4例对症处理好转、1例淤胆型肝病皮质激素治疗有效。结论儿童期急性或慢性严重肝病除外感染、代谢等因素者,应重点追踪患儿用药史、肝功能动态变化、免疫球蛋白、自身抗体及肝组织病理学检查,早期正确诊断和处理有利于疾病恢复,并可避免肝脏不可逆性损害。
Objective To analyze the pathogenesis, clinical features and prognosis of childhood autoimmune hepatitis and drug-induced liver disease. Methods From May 2006 to April 2008, 3 children with autoimmune hepatitis and 5 drug-induced liver disease were admitted to Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. The etiology, clinical manifestations, laboratory tests, treatment and prognosis Retrospective analysis and summary, and review the relevant literature for clinical comparison. Results The three children with autoimmune hepatitis had a history of 6 months to 3 years with severe hepatosplenomegaly, elevated serum IgG, positive autoantibodies, and liver histopathology showed hepatocellular edema, 5 cases of drug-induced liver disease in children with relevant drugs, history of 3 ~ 20d, 4 cases of mild to moderate liver enlargement, 3 cases of acute aspartate aminotransferase 1000U / L or more, two cases of serum IgG levels increased, autoantibodies negative, 4 symptomatic treatment improved, 1 cases of cholestatic liver disease corticosteroids effective. Conclusion In children with acute or chronic severe liver disease infection, metabolism and other factors, should focus on tracking the history of children medication, dynamic changes in liver function, immunoglobulin, autoantibodies and liver histopathological examination, the early diagnosis and treatment of disease-beneficial Recovery, and to avoid irreversible damage to the liver.