中国实用儿科杂志

中国实用儿科杂志 ›› 2010, Vol. 25 ›› Issue (02): 147-.

• 论著 • 上一篇    下一篇

儿童自身免疫性肝炎与药物性肝病临床比较并文献复习

徐三清，刘　艳，方　峰，周　华，黄志华，董永绥   

  1. 华中科技大学同济医学院附属同济医院儿科，武汉　430030
  • 收稿日期:2009-08-12 修回日期:2009-11-15 出版日期:2010-02-06 发布日期:2010-03-09

Clinical comparison of autoimmune hepatitis and drug-induced liver disease in children and review of literature.

  1. Department of Pediatrics，Tongji Hospital，Tongji Medical College affiliated to Huazhong University of Science and Technology， Wuhan 430030，China
  • Received:2009-08-12 Revised:2009-11-15 Online:2010-02-06 Published:2010-03-09

摘要：

分析儿童自身免疫性肝炎与药物性肝病的发病机制、临床特点和预后 。方法　2006年5月至2008年4月华中科技大学同济医学院附属同济医院收治儿童自身免疫性肝炎3例、药物性肝病5例，对其病因、临床表现、实验室检查、治疗方案和预后进行回顾性分析和总结，并复习相关文献进行临床比较。结果　3例自身免疫性肝炎患儿病史6个月至3年、肝脾中至重度增大、血清IgG水平升高、自身抗体阳性、肝组织病理学检查示肝细胞水肿变性、间质及汇管区炎性细胞浸润、皮质激素治疗有效；5例药物性肝病患儿曾应用过相关药物、病史3～20 d、4例肝脏轻至中度肿大、3例急性期天冬氨酸转移酶 1000 U/L以上、2例血清IgG水平升高、自身抗体阴性、4例对症处理好转、1例淤胆型肝病皮质激素治疗有效。结论　儿童期急性或慢性严重肝病除外感染、代谢等因素者，应重点追踪患儿用药史、肝功能动态变化、免疫球蛋白、自身抗体及肝组织病理学检查，早期正确诊断和处理有利于疾病恢复，并可避免肝脏不可逆性损害。

关键词: 肝炎, 自身免疫性, 肝病, 药物性, 儿童

Abstract:

Objective　To compare the pathogenesis， clinical characteristics and prognosis of  autoimmune hepatitis and drug-induced liver

disease in children through case reports and literature review in order to improve the recognition of such diseases . Methods　Analyze

retrospectively and compare the causes， clinical manifestations， laboratory results， treatment protocols and prognosis of 3 inpatients

with autoimmune hepatitis and 5 inpatients with drug-induced liver disease， combined with literature review.  Results　For three patients

with autoimmune hepatitis，there existed illness history of 6 months to 3 years， moderate to severe hepatosplenomegaly， elevated IgG levels

and positive autoantibodies in serum， hepatic hydropic degeneration and interstitial and portal inflammatory cells infiltration in hepatic

histopathologic lesions， good reaction to glucocorticosteroid treatment； but for five patients with drug-induced liver disease， there

existed use of drugs to induce liver disease， illness history of 3 to 20 days， mild to moderate hepatosplenomegaly in four cases， ALT more

than 1000 U/L in acute phases in three cases， elevated serum IgG levels in two cases， negative autoantibodies， recovery after expectant

treatment in four cases， good reaction to glucocorticosteroid treatment in one case with cholestatic liver disease. Conclusion　When

confronted with the patients with acute or chronic severe liver diseases， clinicians should put the emphasis on the investigation of drugs

to induce liver disease and the examination of liver function， IgG， autoantibodies and hepatic histopathologic lesions，in order to clarify

the diagnosis of autoimmune hepatitis or drug-induced liver disease，if infectious， metabolic and other causes are excluded. Early and

correct treatment will be beneficial to the recovery of such diseases and avoidance of irreversible liver damage.

Key words: hepatitis, autoimmune；liver disease, drug-induced；children