Clinical Analysis Of Autoimmune Liver Disease Complicated With Sjogren’s Syndrome

Objective: We analyzed the clinical data of 176 inpatients with autoimmune liver disease(ALD)from the Second Affiliated Hospital of Dalian Medical University,grouped them according to whether they had Sjogren’s syndrome(SS)or not,and investigated the clinical characteristics and disease progression of autoimmune liver disease complicated with Sjogren’s syndrome,so as to provide a reference for clinicians to diagnose and treat the disease.Method: A total of 176 inpatients initially diagnosed with ALD in the Gastroenterology Department,Infection Department and Rheumatology Department of the Second Affiliated Hospital of Dalian Medical University from September 2005 to September2020 were collected.According to whether or not SS was complicated,they were divided into group A: PBC(75 cases)and PBC complicated with SS(40 cases).Group B: AIH(43 cases),AIH complicated with SS(18 cases);Group C: PBC complicated with SS(40 cases),AIH complicated with SS group(18 cases).The gender,clinical diagnosis,age,clinical manifestation,liver function indicators,immunoglobulin,autoantibody,liver histological manifestation and disease progression were collected for analysis.Results: 1.In group A,there were 13 male and 62 female patients with PBC,the male to female incidence ratio was 1:4.77,and the age was 58.67±12.215 years old.There were 1 male and 39 female patients with PBC complicated with SS,the male to female incidence ratio was 1:39,and the age was 60.28±9.969 years old.In group B,there were9 males and 34 females with AIH,and the ratio of male to female was 1:3.78.The age was 60±8.377 years old,and 18 patients with AIH complicated with SS were all female,and the age was 56.06±10.624 years old.In group C,there were 1 male and 39 female patients with PBC complicated with SS,the ratio of male to female was 1:39,the age was 60.28 ± 9.969 years old,and 18 female patients with AIH complicated with SS,the age was 56.06 ± 10.624 years old.The gender difference between group A and group B was statistically significant,P < 0.05.Compared with PBC alone and AIH alone,the female patients with PBC complicated with SS and AIH complicated with SS were more and the male patients were less.The gender of group C was not statistically significant,and the age at diagnosis of group A,B and C was not statistically significant.2.The incidence of dry mouth/dry eye symptoms in PBC complicated with SS and AIH complicated with SS were significantly higher than those in PBC and AIH.P <0.05,the difference was statistically significant.Compared with PBC complicated with SS and AIH complicated with SS,pruritus and skin sclera yellow staining were more common in PBC and AIH.P < 0.05,the difference was statistically significant.Compared with AIH complicated with SS,the incidence of pruritus in PBC complicated with SS was higher.Among the three groups,there was no statistically significant difference in fatigue,abdominal distension,nausea/vomiting,anorexia and other clinical manifestations.3.The ALP,TBIL and DBIL of PBC in group A were higher than those of PBC complicated with SS.Compared with PBC,Ig G was significantly increased in PBC complicated with SS.In group B,TBIL and DBIL of AIH were higher than those of AIH complicated with SS.In group C,ALT and AST of PBC complicated with SS were lower than those of AIH complicated with SS,but ALP,GGT and Ig M were higher than those of AIH complicated with SS.P < 0.05,the difference was statistically significant.Other liver function indexes and immunoglobulin had no statistical significance.4.In group A and B,the positive rate of autoantibody Ro-52 was higher in patients with PBC complicated with SS and AIH complicated with SS than in those with PBC or AIH,respectively.In group C,the positive rates of AMA-M2,M2-3E,SP100,PML,GP210,CENP B in patient with PBC complicated with SS were higher than AIH complicated SS,while the positive rate of SMA,SLA/LP,p ANCA in patient with AIH complicated SS were higher than PBC complicated SS.P < 0.05,the difference was statistically significant.5.The positive rate of bile duct lesions and cholestasis of PBC complicated with SS in group C was higher than that of AIH complicated with SS,but the positive rate of rose-like garland change in AIH complicated with SS was higher than that in PBC complicated with SS,P < 0.05,the difference was statistically significant.There was no statistical significance in the pathological changes between group A and group B(P > 0.05).6.The disease progression of ALD patients was analyzed,and the incidence of liver cirrhosis in the first year,the third year and the fifth year were as follows: in group A,PBC was 4%,13.8%,68.3%,PBC complicated with SS was 0.0%,7.3%,57.5%,P = 0.295;in group B,AIH was 7%,22.7%,75.3%,AIH complicated with SS was 0.0%,18.4%,60.8%,P = 0.505;in group C,PBC complicated with SS was 0.0%,7.3%,57.5%,AIH complicated with SS was 0.0%,18.4%,60.8%,P=0.610.There was no significant difference among the three groups.Conclusion: 1.ALD and ALD complicated with SS are most common in middle-aged and elderly women,ALD complicated with SS is not rare,patients can have the clinical characteristics of ALD and SS at the same time.2.When ALD patients appear dry eyes and dry mouth,eye examination and labial gland biopsy should be performed as soon as possible to determine whether SS is complicated and treat it.3.Compared with pure PBC,significant increase of Ig G was more common in patients with PBC complicated with SS.Ig G can help determine whether patients with PBC are complicated with SS,and is more valuable in patients who have not been treated for the first time.4.The degree of liver injury in ALD patients complicated with SS is less than that in ALD patients alone.When multiple autoimmune diseases exist at the same time,the clinical characteristics of the disease may change.However,there was no significant change in disease progression.