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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

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
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    2017-07-08 jeanqiuqiu
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    2017-03-19 syscxl
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