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自身免疫性肝炎不典型发作1例报告

周梦婷 韩红梅

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Citation:

自身免疫性肝炎不典型发作1例报告

DOI: 10.3969/j.issn.1001-5256.2022.11.024
伦理学声明:本例报告已获得患者知情同意。
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:周梦婷负责资料分析,撰写论文,修改论文;韩红梅负责拟定写作思路,指导撰写文章并最后定稿。
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    通信作者:

    韩红梅,hanhm79@126.com

A diagnosis of atypical autoimmune hepatitis: A case report

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    Corresponding author: HAN Hongmei, hanhm79@126.com(ORCID: 0000-0001-7147-4447)
  • 图  1  AIH患者肝组织病理学表现

    注:a,肝小叶结构轻度紊乱(HE染色,×40);b,汇管区可见浆细胞(黑色箭头所示);小胆管保留,上皮排列不整,可见炎性细胞浸润至胆管上皮间,汇管区周边可见轻度细胆管反应(HE染色,×100);c,汇管区扩大,中度炎性细胞浸润,以单个核细胞浸润为主,中度界面炎(红色箭头所示)(HE染色,×200);d,汇管区间质未见明显纤维组织增生,小叶内见点灶状坏死,部分坏死灶融合,窦内可见明显炎性细胞浸润,亦可见浆细胞(HE染色,×400)。

    Figure  1.  Hepatology histopathologic features in patients with AIH

    图  2  AIH患者转氨酶变化

    Figure  2.  Changes of transaminase in patients with AIH

    图  3  AIH患者ALP、GGT变化

    Figure  3.  Changes of ALP and GGT in patients with AIH

    图  4  AIH患者IgG变化

    Figure  4.  Changes of IgG in patients with AIH

  • [1] 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[J]. Hepatology, 2020, 72(2): 671-722. DOI: 10.1002/hep.31065.
    [2] YUAN X, DUAN SZ, CAO J, et al. Noninvasive inflammatory markers for assessing liver fibrosis stage in autoimmune hepatitis patients[J]. Eur J Gastroenterol Hepatol, 2019, 31(11): 1467-1474. DOI: 10.1097/MEG.0000000000001437.
    [3] GATSELIS NK, ZACHOU K, KOUKOULIS GK, et al. Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics[J]. World J Gastroenterol, 2015, 21(1): 60-83. DOI: 10.3748/wjg.v21.i1.60.
    [4] SEBODE M, WEILER-NORMANN C, LIWINSKI T, et al. Autoantibodies in autoimmune liver disease-clinical and diagnostic relevance[J]. Front Immunol, 2018, 9: 609. DOI: 10.3389/fimmu.2018.00609.
    [5] KATSUMI T, UENO Y. Epidemiology and surveillance of autoimmune hepatitis in Asia[J]. Liver Int, 2022, 42(9): 2015-2022. DOI: 10.1111/liv.15155.
    [6] CAPRA AP, CHIARA E, BRIUGLIA S. Autoimmune hepatitis in genetic syndromes: A literature review[J]. World J Hepatol, 2021, 13(10): 1328-1340. DOI: 10.4254/wjh.v13.i10.1328.
    [7] GUO L, ZHOU L, ZHANG N, et al. Extrahepatic autoimmune diseases in patients with autoimmune liver diseases: a phenomenon neglected by gastroenterologists[J]. Gastroenterol Res Pract, 2017, 2017: 2376231. DOI: 10.1155/2017/2376231.
    [8] MANNS MP, LOHSE AW, VERGANI D. Autoimmune hepatitis-Update 2015[J]. J Hepatol, 2015, 62(1 Suppl): S100-S111. DOI: 10.1016/j.jhep.2015.03.005.
    [9] SIRBE C, SIMU G, SZABO I, et al. Pathogenesis of autoimmune hepatitis- cellular and molecular mechanisms[J]. Int J Mol Sci, 2021, 22(24): 13578. DOI: 10.3390/ijms222413578.
    [10] VENTO S, GUELLA L, MIRANDOLA F, et al. Epstein-Barr virus as a trigger for autoimmune hepatitis in susceptible individuals[J]. Lancet, 1995, 346(8975): 608-609. DOI: 10.1016/s0140-6736(95)91438-2.
    [11] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Autoimmune hepatitis[J]. J Hepatol, 2015, 63(4): 971-1004. DOI: 10.1016/j.jhep.2015.06.030.
    [12] Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of autoimmune hepatitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796

    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)[J]. 临床肝胆病杂志, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796
    [13] BINICIER OB, GVNAY S. The efficacy and adverse effects of budesonide in remission induction treatment of autoimmune hepatitis: a retrospective study[J]. Croat Med J, 2019, 60(4): 345-351. DOI: 10.3325/cmj.2019.60.345.
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  • 收稿日期:  2022-02-25
  • 录用日期:  2022-05-04
  • 出版日期:  2022-11-20
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