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儿童自身免疫性肝炎10例临床特征分析
Clinical features of autoimmune hepatitis in children: An analysis of 10 cases
文章发布日期:2018年09月30日  来源:  作者:陈杰,刘燕敏,黄春洋,等  点击次数:437次  下载次数:79次

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【摘要】:目的分析儿童自身免疫性肝炎(AIH)的临床特点及治疗转归。方法回顾性分析2008年12月-2017年12月在首都医科大学附属北京佑安医院住院治疗的10例儿童AIH 患者的临床、肝脏病理、治疗转归及随访资料。结果患儿年龄3~16 岁,中位年龄10岁,女性占70%。1型5例,2型5例。3例(30%)急性起病,2例(20%)亚急性起病,5例(50%)慢性起病。转氨酶升高8例(80%),胆红素升高7例(70%);GGT升高7例(70%);IgG升高6例(60%)。7例接受肝脏病理检查的患儿中炎症程度≥G3者4例,纤维化分期≥S3者4例,界面性炎症4例,浆细胞浸润5例,玫瑰花环4例;淋巴细胞浸润7例。1例患者死亡,1例失访,有效6例,复发1例,疗效不佳1例。5例2型AIH患者中,4例采用糖皮质激素联合硫唑嘌呤治疗,病情得到有效控制。结论儿童AIH临床表现复杂,个别患者病情重。2型患者多需要糖皮质激素联合硫唑嘌呤治疗。
【Abstract】:ObjectiveTo investigate the clinical features and treatment outcome of children with autoimmune hepatitis (AIH). MethodsA retrospective analysis was performed for the clinical data, liver pathology, treatment outcome, and follow-up data of 10 children with AIH who were treated in Beijing YouAn Hospital, Capital Medical University, from December 2008 to December 2017. ResultsThe children were aged 3-16 years (median 10 years), and girls accounted for 70%. Of all patients, 5 had type 1 AIH, and 5 had type 2 AIH; 3 (30%) had an acute onset, 2 (20%) had a subacute onset, and 5 (50%) had a chronic onset. Elevation of aminotransferases was found in 8 children (80%), and elevations of bilirubin, gamma-glutamyl transpeptidase, and immunoglobulin G were found in 7 children (70%), 7 children (70%), and 6 children (60%), respectively. Among the 7 children who underwent liver biopsy, 3 had grade ≥3 liver inflammation, 4 had stage ≥3 liver fibrosis, 5 had interface hepatitis, 5 had plasma cell infiltration, 4 had rosette-like annulation of hepatocytes, and 7 had lymphocyte infiltration. One child died, and one was lost to follow-up; among the other 8 children, 6 had good response, 1 experienced recurrence, and one had poor response. 4 patients with type 2 AIH were treated with glucocorticoids combined with azathioprine, the disease was effectively controlled. ConclusionChildren with AIH have diverse clinical manifestations, and some children have serious conditions. Most patients with type 2 AIH need the treatment of glucocorticoids combined with azathioprine.
【关键字】:肝炎, 自身免疫性; 疾病特征; 儿童
【Key words】:hepatitis, autoimmune; disease attributes; child
【引证本文】:CHEN J, LIU YM, HUANG CY, et al. Clinical features of autoimmune hepatitis in children: An analysis of 10 cases[J]. J Clin Hepatol, 2018, 34(10): 2164-2168. (in Chinese)
陈杰, 刘燕敏, 黄春洋,等. 儿童自身免疫性肝炎10例临床特征分析[J]. 临床肝胆病杂志, 2018, 34(10): 2164-2168.

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