重庆地区111例自身免疫性肝病流行病学及危险因素分析

Epidemiology and analysis of the risk factors of autoimmune liver disease

摘要:

目的：探讨不同类型自身免疫性肝病流行病学特征及相关危险因素。方法：选取2012年8月至2018年8月于重庆医科大学附属第一医院就诊的111例自身免疫性肝病患者为研究对象，按照诊断分为自身免疫性肝炎（autoimmune hepatitis，AIH）、原发性胆汁性肝硬化（primary biliary cirrhosis，PBC）、原发性硬化性胆管炎（primary sclerosing cholangitis，PSC）及重叠综合征（overlapping syndrome，OS），因PSC组患者仅1例，不纳入统计。回顾性分析患者性别、年龄、个人史、伴随疾病和实验室检查资料在各组中的差异。结果：①AIH、PBC、OS组平均发病年龄分别为（53.29±12.43）、（62.91±11.61）、（63.05±11.40）岁，各组间差异具有统计学意义（P＜0.01）。家族遗传史在组间差异具有统计学意义（P＜0.05）。②实验室指标中，抗线粒体抗体M2型在AIH、PBC、OS各组中阳性率分别为23.2%、52.8%、70.5%，各组间差异具有统计学意义（P<0.01）。AIH及PBC组间天门冬氨酸氨基转移酶（P<0.01）、胆碱酯酶（P<0.05）差异具有统计学意义。天门冬氨酸氨基转移酶（P<0.05）、胆碱酯酶（P<0.05）及碱性磷酸酶（P<0.05）在3组间差异具有统计学意义。③吸烟、性别、饮酒、用药史、临床症状、EB病毒及巨细胞病毒感染、体液免疫在各组间差异无统计学意义（P＞0.05）。结论：AIH是自身免疫性肝病的最常见类型。AIH在各类型自身免疫性肝病中起病年龄较小，不同类型自身免疫性肝病有一定遗传倾向。天门冬氨酸氨基转移酶及胆碱酯酶在AIH中升高尤为明显，胆碱酯酶在PBC中升高更为显著。抗线粒体抗体M2型阳性率在重叠综合征中最高。作为自身免疫性肝病的危险因素，吸烟、性别、饮酒、用药史、EB病毒及巨细胞病毒感染对自身免疫性肝病的分组鉴别意义有限。

Abstract:

Objective：To investigate the epidemiologic feature and related risk factors of different type of autoimmune liver diseases （ALD）. Methods：A total of 111 patients with ALD from August 2012 to August 2018 in our hospital were selected as study objects and were divided into autoimmune hepatitis（AIH），primary biliary cirrhosis（PBC），primary sclerosing cholangitis（PSC） and AIH-PBC overlapping syndrome（OS） according to the diagnosis. The PSC group had only one patient and was excluded. The differences of gender，age，personal history，documents related with concomitant diseases and laboratory examination in each group were retrospec－tively analyzed. Results：The average onset age in AIH，PBC，and OS groups was（53.29±12.43） years old，（62.91±11.61） years old and （63.05±11.40） years old，respectively；the difference among groups was statistically significant（P<0.01）. The genetic family history was statistically significant among groups（P<0.05）. The positive rate of anti-mitochondrial antibody M2 in the AIH，the PBC and the OS group were 23.2%，52.8% and 70.5%，respectively，with statistical significance（P<0.01）. Aspartate aminotransferase（P<0.01） and cholinesterase（P<0.05） were statistically significant between the AIH group and the PBC group. Aaspartate aminotrans－ferase（P<0.05），cholinesterase（P<0.05） and alkaline phosphatase（P<0.05） among three groups had significant differences. Smoking，drinking，gender，medication history，clinical symptoms，EB virus and cytomegalovirus infection，and humoral immunity were not sta－tistically different among three groups（P>0.05）. Conclusion：AIH is the most common type of ALD. AIH has a younger onset in all types of ALD，and different types of ALD have a certain genetic predisposition. Aspartate aminotransferase and cholinesterase are par－ticularly elevated in AIH，and cholinesterase is more prominent in PBC. The positive rate of anti-mitochondrial antibody M2 type is the highest in OS. As for risk factors，smoking，gender，drinking，medication history，EB virus and cytomegalovirus infection have limit－ed significance in the group identification of ALD.