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Medicine：HIV感染患者罹患自身免疫性肝的病例报道：罕见但具有治疗启示的重要诊断

2017-03-18 MedSci MedSci原创

自身免疫性肝炎人免疫缺陷病毒肝细胞毒性肝脏损伤肝脏移植
关注

慢性肝脏疾病是HIV患者病残和病死的主要原因之一，然而，自身免疫性肝炎在HIV患者中却鲜有报道。我们旨在评估同时罹患HIV和自身免疫性肝炎的队列患者，识别其临床表现及预后。

患者关注点：

伴有HIV感染的自身免疫性肝炎患者的治疗、长期预后和潜在的免疫抑制状态下治疗的安全性。


自身免疫性肝炎、人免疫缺陷病毒、肝细胞毒性、肝脏损伤、肝脏移植
干预：

我们对同时罹患HIV和自身免疫性肝炎患者的基于组织学、血清学、生物化学、人口学及临床数据进行了回顾性分析

结果：

五为患者被确认患有自身免疫性肝炎，4/5为女性，均为非洲人或非洲裔美国人。自身免疫性肝炎诊断的平均年龄为46.6±13.4岁。所有的患者均通过性活动感染HIV，CD4阳性细胞计数大于250 cells/uL（456-1011 cells/uL），且自身免疫性肝炎诊断时HIV病毒负荷均低于检测下限。一例患者表现为急性肝功能衰竭而进行肝脏移植，肝移植术后出现自身免疫性肝炎。诊断时，AST平均水平为350±448U/L， ALT为247±190U/L，胆红素7±12mg/dL，碱性磷酸酶126±53U/L。所有患者均通过肝脏病理活检确诊。所有患者均通过强的松和咪唑巯嘌呤成功治疗，且未出现CD4阳性细胞小于250cells/uL，无感染并发症及明显的副作用。

经验：

自身免疫性肝炎出现在HIV控制良好的患者。在所观察到的病例队列中，使用强的松和咪唑巯嘌呤等免疫抑制剂是安全有限的，可诱导肝炎缓解，且无明显的并发症或发生机会感染。

原始出处：
Kia L1， Beattie A， Green RM. Green RM.Autoimmune hepatitis in patients with human immunodeficiency virus (HIV)： Case reports of a rare， but important diagnosis with therapeutic implications. Medicine(Baltimore). 2017 Feb；96(7)：e6011. doi： 10.1097/MD.0000000000006011
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    2017-07-22 kalseyzl

    #CIN#

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    2017-07-08 jeanqiuqiu

    #DIC#

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    2017-03-19 syscxl

    #罕见#

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    2017-03-19 ms1692212821629096

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    2017-03-19 ms3994565386320060

    #Med#

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42岁女性患者，因“皮肤黄染7月余”入院，其检查结果如下。请大家猜猜看，该患者得的是什么病？ 　　本期首位猜中读者：@maxiongmd（新浪微博网友） 　　每期“临床挑战”栏目见报前，将提前1周在我周刊微博征集答案（新浪微博：@中国医学论坛报社消化肝病周刊） 　　maxiongmd：图像不是很清楚，但从右上角图看来，界面性肝炎和玫瑰花结

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