老年自身免疫性肝炎患者的临床特征及自身抗体水平

Clinical characteristics and autoantibody levels in elderly patients with auto-immune hepatitis

摘要:

目的 探讨老年自身免疫性肝炎(AIH)患者的临床特征及自身抗体水平。方法 回顾性分析2013年1月至2018年1月期间首都医科大学附属北京佑安医院肝病免疫科收治的112例AIH患者的临床资料,按年龄分为老年组(≥60岁,33例)和中青年组(＜60岁,79例)。统计分析2组患者临床资料、生化指标和自身抗体指标。采用SPSS 16.0软件进行数据处理,根据数据类型,组间比较分别采用t检验、Mann-Whitney检验或χ²检验。结果 老年组患者乏力(54.5% vs 78.5%)和恶心呕吐 (18.2% vs 39.2%)症状患者显著少于中青年组,肝硬化(36.4% vs 17.7%)及合并肝外自身免疫病 (33.3% vs 16.5%)患者显著多于中青年组,老年患者血小板计数[(155.2±76.1)×10⁹/L vs (186.2±77.2)×10⁹/L]显著低于中青年组,血尿素氮[(5.1±1.6) vs(4.4±1.3)mmol/L]及血肌酐[(62.1±16.2) vs (57.5±15.1)μmol/L]浓度显著高于中青年组,差异均有统计学意义(P<0.05)。老年组抗核抗体阳性率高于中青年组(87.9% vs 79.7%),但差异无统计学意义(P>0.05)。结论 老年组AIH患者合并肝硬化、肝外免疫病的比例高,肾功能降低,年龄相关的免疫功能紊乱可能影响患者的临床表现。

Abstract:

Objective To investigate the clinical characteristics and autoantibody levels in the elderly patients with autoimmune hepatitis (AIH). Methods A retrospective analysis was carried out on 112 AIH patients admitted to our department from January 2013 to January 2018. According to their age, these patients were divided into the aged group (≥60 years old, n=33) and the non-aged group (<60 years old, n=79). Their clinical data, biochemical indicators, and autoantibody levels were collected and compared between the 2 groups. SPSS statistics 16.0 was used to perform the statistical analysis. According to the data type, Student′s t test, Mann-Whitney test or Chi-square test was employed for comparison between groups. Results The incidence rates of symptoms, such as fatigue (54.5% vs 78.5%) and nausea and vomiting (18.2% vs 39.2%) were significantly lower, but those of cirrhosis (36.4% vs 17.7%) and complication with extrahepatic autoimmune diseases (33.3% vs 16.5%) were obviously higher in the aged group than the non-aged group. The aged group had notably lower platelet count [(155.2±76.1)×10⁹/L vs (186.2±77.2)×10⁹/L], while remarkably higher concentrations of blood urea nitrogen [(5.1±1.6) vs (4.4±1.3)mmol/L] and creatinine [(62.1±16.2) vs (57.5±15.1)μmol/L] when compared with the other group (all P<0.05). The positivity rate of anti-nuclear antibody was higher in the aged group than the other group (87.9% vs 79.7%), though without statistically significance (P>0.05). Conclusion The elderly AIH patients are prone to cirrhosis, extrahepatic immune disease, and renal function decline. Age-related immune dysfunction may affect the clinical manifestations in these patients.