| Background: Autoimmune hepatitis (AIH) is an unresloving hepatocellularinflammation of unknown causes. Diagnosis of AIH requires the presence ofinterface hepatitis on histological examination, hypergammaglobulinemia,abnormally elevated serum transaminase levels, and liver associatedautoantibodies in the serum. the disease is rare and global in ages, and theunfavourable prognosis of AIH can be seen in pretreatment. the clinical casescould be evitably misdiagnosed and miss-diagnosed due to the low incidence rate.In China, there aren't the correspondenting researches of the incidence situationsand clinical characters of AIH so much, so our job aim to carry out such rearchesabout these aspects of AIH. Methods: The retrospective analysis was performed in this study to 29 AIHcases hospitalized in our hospital, which were divided into type I AIH group andtypeⅡAIH group according to the serum level of antibody, And then weredivided into acute-onset AIH group and chronic AIH group according to theirclinical situation. The observing contents include (1) general state: Sex, structureof disease, age. (2) clinical symptom, physical sign,accompanying by autoallergicdisease, admitting diagnosis, incidence of hepatic cirrhosis. (3) laboratoryexamination: routine examination of blood, Hepatic function , virology ,immunology, the feature of biopsy of histological anatomy. (4) turnover andprognosis. All patients fulfilled the diagnostic criteria according to a scoringsystem proposed in 1999. Results: 1,female is susceptible to the diease,and the peak age of onset isbetween forty and fifty.type I was seen frequently while type II was rare.2,thedesease was got by the patient who has an acute or even fulminant presentation ora chronic presentation, which can be diagnosed as acute onset AIH and chronicAIH respectively.3,1) the clinical manifestation were not obvious specificity,mainly including fatigue ,intake difficulty,deepen the urine corlor, jaundice,the virus can be regardes as the etiopathogenisis of AIH which also probablyaccompanied by the aotuimmune desease 。2) the gammaglobulinemia increasedfrequently besides the high serum level of aminotransferase , alkalinephosphatase, bilirubin,and the seroglobulin and immunoglobulin G also rose indiverse levels.4,1)the chief clinical manifestations of acute-onset AIH weredeepen urine color ,jaundice, sensitive to percussion in hepatic region, howeverthe chronicity usually showed fatigue , abdominal distention , andsplenohepatomegalia in clinical features. 2) aminotransferase, bilirubin weresignificantly more prevalent in acute-onset than chronic AIH,howeverimmunoglobulin G were fewer in patients with acute-onset than in those withchronic AIH .and No other differences were noted in antibody parameter . 3)therewere significantly differences in prognosis of acute-onset and chronic AIH,and theformer were worse.and the scores of acute-onset AIH was lower compared to thechronic AIH.5,type I AIH of this group mostly similar to the elder group of whitepeople in age of onset and clinical characteristic.Discussion: Most of AIH patients exhibited clinical and histopathologicfeatures of chronic hepatitis. However, an acute or even fulminant presentation ofAIH has long been recognized and such cases have been referred to as 'acuteonset' AIH,. the admitting diagnoses of a tiny part of patients were liver cirrhosiswhich revealed the delitescence courses in some patients. so the patients withacute hepatitis or chronic hepatitis should be considered the possibility of thediagnose of AIH. the mortality ages of type I AIH presented two peaks of ten totwenty-five and forty-five to seventy of white peple, the differences of which mayrelate to different genetic suspectibility among different races.the yonger group ofwhite presented the severe symptoms, prone to recure, while the older grouppresent the comparatively slight symptom, better response to immunodepressiveagent, and frequently cooccured with the autoimmune deseases .in this study,theage of onset and clinical features of type I AIH, which age seen only peak wasmainly within forty and fifty, were similar to the older group, it's clinical syptomsmainly included fatigue,intake difficulty, deepen urine color, jaudance, fever,abdominal distention, combined with the autoimmune deseases, possibility ofvirus infection, whose the gammaglobulinemia increased frequently besides thehigh serum level of aminotransferase,alkaline phosphatase,bilirubin, and theseroglobulin and immunoglobulin G also rose in diverse levels. The obviousdifferences of clinical manifestation,sero-enzyme,AIH scores of most cases canbe seen between acute onset autoimmune hepatitis and chronic one, which agreedwith the results of the foreign study. There were no definite changes ofmorphology in histological anatomy in this kind of deseases, except for the certainpathological features. In this analysis, interface hepatitis, lobular hepatitis, androselike changes, what's more, lobular central necrosis can be seen in one case ofacute-onset hepatitis which were regarded as the characteristic change. long termusage of corticosteroids caused lots of complications.so to cure the patients ofolder ,slight pathogenetic condition,combined with the type B hepatitis orulceration, the glycyrrhizin should be chose firstly, which resembled thehormonelike effects and less side effects.there some cases of using this kind ofdrugs had the clinical therapeutics success to get the histoligical relief.the rate ofcomplete responses of this study were 68.42%, which implied still many patientsneeded other therapies besides the criteria therapy. there were significantlydifferences of therapeutic results between acute-onset AIH and chronic one, andthat agree with the freign corresponding results,and the unfavourable prognosisimplied that the former had a bad response to immunodepressive agent andfacility to recurrent.so far usage of other immunodepressive agents succeeded insmall range instead of classic therapy,but the long term control study still shouldbe carry out so as to observe the therapeutic effect and side effects.
|
PDF Full Text Request