实用器官移植电子杂志 ›› 2018, Vol. 6 ›› Issue (6): 458-460.DOI: 10.3969/j.issn.2095-5332.2018.06.011

• 论著 • 上一篇    下一篇

血色病合并乙型病毒性肝炎肝移植受者术后早期新发自身免疫性肝炎 1 例

范铁艳,陈虹,邱爽   

  1. 中国人民解放军总医院第三医学中心器官移植研究所,北京 100039
  • 出版日期:2018-11-20 发布日期:2021-06-24

De novo autoimmune hepatitisonearly periodinliver transplantation recipients combined with hemochromatosis and hepatitis B infection:a case report and review

Fan Tieyan,Chen Hong,Qiu Shuang.   

  1. Organ Transplantation Institute,The Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China
  • Online:2018-11-20 Published:2021-06-24

摘要:

目的 回顾性分析血色病合并乙型病毒性肝炎肝移植受者术后早期新发自身免疫性肝炎患者 的临床特征、诊疗及预后。方法 入选本院近 10 年来血色病合并乙型病毒性肝炎肝移植受者术后早期新发 自身免疫性肝炎 1 例。新发自身免疫性肝炎诊断标准 :血清总 IgG 升高 ;自身免疫抗体阳性 ;慢性肝炎的 组织学特征;无病毒性肝炎。根据具体的标准进行评分,6 ~ 7 分者可能为自身免疫性肝炎,≥ 7 分者可确诊。 结果 1 例女性患者 γ 球蛋白 29.4%,IgG 27.5 g/L,自身抗体谱正常。新发自身免疫性肝炎发生时间为肝 移植术后 1 个月。加用甲泼尼龙 12 mg/d 治疗 1 个月后转氨酶恢复正常。结论 肝移植术后早期合并新发自 身免疫性肝炎患者较为少见。早期诊断与合理治疗方案是改善预后的关键。

关键词: 新发自身免疫性肝炎 , 肝移植术后

Abstract:

Objective To retrospectively analyze the clinical and prognostic features,and the diagnosis and treatment strategies of denovo autoimmune hepatitis in patients combined with hepatitis B infection and hemochromatosis after liver transplantation in the early postoperative period. Methods In the past 10 years, 1 patient with hemochromatosis combined with hepatitis B who received liver transplantation in our hospital was diagnosed with autoimmune hepatitis in the early postoperative period. New diagnostic criteria of denovo autoimmune hepatitis :elevated serum IgG ;positive autoimmune antibody ;histological features of chronic hepatitis ;nonhepatitis. According to the specific criteria,6 ~ 7 points may be suspected with,more than 7 points can be diagnosed with autoimmune hepatitis. Results Only one female patient was dignosed with autoimmune hepatitis in 1 month after liver transplantation. γ globulin was 29.4%. IgG was 27.5 g/L. But autoantibody spectrum was normal. Transaminase was normal under the treatment of 12 mg/d of methylprednisolone after one month. Conclusion De novo autoimmune hepatitis after liver transplantation in the early postoperative period is rare. Early diagnosis and rational treatment are keys for improving its prognosis.

Key words: De novo autoimmune hepatitis, Liver transplantation