自身免疫性肝炎患者病理学损伤模式与激素应答的影响因素分析

田爱平; 王富春; 毛永武; 李琼; 李子怡; 张万洁; 毛小荣; 蒋珍秀

doi:10.16766/j.cnki.issn.1674-4152.004329

自身免疫性肝炎患者病理学损伤模式与激素应答的影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004329

1.
兰州大学第一医院感染科，甘肃兰州 730013
2.
首都医科大学附属北京佑安医院，北京 100069
3.
兰州大学第一临床医学院，甘肃兰州 730000
4.
兰州大学第一医院神经内科

基金项目:

甘肃省重点研发计划 24YFFA037

甘肃省自然科学基金项目 21JR7RA365

详细信息

通讯作者:
毛小荣，E-mail：maoxr@lzu.edu.cn

中图分类号: R575.1
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- 被引次数: 0
出版历程
- 收稿日期: 2025-01-26
- 网络出版日期: 2026-04-01

A clinical study on pathological injury patterns and factors influencing hormone response in patients with autoimmune hepatitis

1.
Department of Hepatology, the First Hospital of Lanzhou University, Lanzhou, Gansu 730013, China

摘要

摘要: 目的分析自身免疫性肝炎(AIH)患者的临床特征及肝活检病理损伤模式，以探究AIH患者激素应答与否的影响因素，为临床诊治提供新依据。方法回顾性分析2020年12月—2022年12月兰州大学第一医院经肝脏活组织病理检查诊断明确且经糖皮质激素治疗的84例AIH患者。获取患者的临床资料、肝活检相关信息及随访数据，根据患者6个月内对激素治疗的应答情况将其分为完全应答组(52例)与不完全应答+无应答组(32例)，根据患者的肝脏病理活检结果将其分为A组(病理损伤为小叶炎，12例)、B组(病理损伤可见明显的小叶炎和界面炎，23例)、C组(病理损伤为界面炎，49例)，分析病理学损伤模式等因素对AIH患者6个月内激素应答的影响。结果 84例患者中，女性占比较高(76.2%，64例)，男性占23.8%(20例)，患者年龄为(50.6±11.4)岁。2组患者免疫球蛋白G(IgG)、免疫球蛋白M(IgM)及病理损伤模式差异均有统计学意义(P＜0.05)。多因素分析显示，IgG、IgM及病理损伤模式均为AIH患者半年内激素应答的独立影响因素(P＜0.05)。结论血清IgG和IgM水平较低的AIH患者相对于水平较高者，半年内发生激素完全应答的概率增加；相较于病理损伤模式为界面炎的AIH患者，以小叶炎合并界面炎为主的患者在半年内更易产生激素治疗后的完全应答。
- 自身免疫性肝炎 /
- 病理损伤模式 /
- 免疫球蛋白 /
- 激素应答
Abstract: Objective To analyze the clinical characteristics and liver biopsy-assessed pathological injury patterns in patients with autoimmune hepatitis (AIH) and to explore factors influencing the hormone response, aiming to provide new insights for clinical diagnosis and treatment. Methods We retrospectively analyzed data from 84 AIH patients diagnosed by liver biopsy and treated with glucocorticoids at the First Hospital of Lanzhou University from December 2020 to December 2022. Clinical data, liver biopsy information, and follow-up data were collected. Patients were divided into two groups based on their hormone response within 6 months: a complete response group (n=52) and an incomplete response or non-response group (n=32). Based on liver biopsy results, patients were further categorized into Group A (lobulitis, n=12), Group B (lobulitis combined with interface hepatitis, n=23), and Group C (interface hepatitis, n=49). We employed t-tests, Chi-square tests, non-parametric tests, and binary logistic regression to analyze the impact of pathological injury patterns and other factors on hormone response within 6 months in AIH patients. Results Among the 84 patients, 76.2% were female (n=64), and 23.8% were male (n=20), with a mean age of (50.6±11.4) years. Significant differences were observed between the two response groups in immunoglobulin G (IgG) levels, immunoglobulin M (IgM) levels, and pathological injury patterns (P < 0.05). Multivariate analysis revealed that IgG, IgM, and pathological injury patterns were independent factors influencing hormone response within 6 months in AIH patients (P < 0.05). Conclusion AIH patients with lower serum IgG levels were more likely to achieve a complete hormone response within 6 months compared to those with higher levels. Compared to AIH patients with interface hepatitis as the predominant pathological injury pattern, patients with lobulitis combined with interface hepatitis were more likely to achieve a complete hormone response to glucocorticoid therapy within 6 months.
- Autoimmune hepatitis /
- Pathological injury pattern /
- Immunoglobulin /
- Hormonal response

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表 1 2组AIH患者基线资料比较

Table 1. Comparison of baseline data of two groups of AIH patients

项目	完全应答组(n=52)	不完全应答+无应答组(n=32)	统计量	P值
性别(男/女, 例)	40/12	24/8	0.040^a	0.841
年龄(x±s, 岁)	50.6±10.6	51.0±12.7	0.164^b	0.870
BMI(x±s)	23.4±2.4	22.4±3.1	1.744^b	0.085
HB(x±s, g/L)	131.7±22.6	127.4±23.2	0.836^b	0.405
WBC[M(P₂₅, P₇₅), ×10⁹/L]	4.7(3.4, 6.3)	4.7(3.0, 6.2)	-0.212^c	0.832
PLT[M(P₂₅, P₇₅), ×10⁹/L]	138.5(88.5, 191.3)	121.0(74.3, 181.0)	-0.949^c	0.343
ALT[M(P₂₅, P₇₅), U/L]	127.7(58.0, 314.5)	85.0(65.7, 205.4)	-0.599^c	0.549
TBIL[M(P₂₅, P₇₅), μmol/L]	45.8(23.5, 163.9)	34.4(22.0, 102.1)	-0.912^c	0.362
ALP[M(P₂₅, P₇₅), U/L]	155.1(127.2, 204.0)	182.0(133.5, 600.8)	-1.874^c	0.061
γ-GGT[M(P₂₅, P₇₅), U/L]	152.6(66.2, 270.5)	153.5(79.4, 445.2)	-1.013^c	0.311
IgG[例(%)]			11.169^a	0.001
＜16.0 g/L	29(55.8)	6(18.8)
≥16.0 g/L	23(44.2)	26(81.2)
IgM[例(%)]			4.523^a	0.033
＜2.5 g/L	35(67.3)	14(43.8)
≥2.5 g/L	17(32.7)	18(56.2)
病理损伤模式[例(%)]			11.647^a	0.003
A组	9(17.3)	3(9.4)
B组	20(38.5)	3(9.4)
C组	23(44.2)	26(81.3)
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 影响AIH患者激素应答疗效的多因素分析

Table 2. Multivariate analysis of factors affecting hormone response efficacy in AIH patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
IgG≥16.0 g/L	-1.440	0.587	6.025	0.014	0.237	0.075~0.748
IgM≥2.5 g/L	-1.295	0.560	5.355	0.021	0.274	0.091~0.820
病理损伤模式^a
A组	1.108	0.838	1.747	0.186	3.028	0.586~15.651
B组	2.055	0.749	7.534	0.006	7.808	1.800~33.873
注：完全应答=1，未达到完全应答=0；IgG≥16.0 g/L和IgM≥2.5 g/L赋值为1，IgG＜16.0 g/L及IgM＜2.5 g/L赋值为0；病理损伤模式，A组=(1, 0, 0)，B组=(0, 1, 0)，C组=(0, 0, 1)。^a以C组为参照。

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