Analysis of clinical diagnosis and treatment in chronic hepatitis B combined with autoimmune hepatitis
10.3760/cma.j.cn501113-20190120-00020
- VernacularTitle:慢性乙型肝炎合并自身免疫性肝炎的临床诊治分析
- Author:
Xiaoqin LIN
1
;
Li SHENG
;
Xiao XIAO
;
Qixia WANG
;
Qi MIAO
;
Canjie GUO
;
Jing HUA
;
Xiong MA
Author Information
1. 福建医科大学孟超肝胆医院肝病科，福州 350025
- Keywords:
Hepatitis, autoimmune;
Hepatitis B, chronic;
Diagnose;
Treatment
- From:
Chinese Journal of Hepatology
2020;28(4):351-356
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical diagnosis and therapeutic method in chronic hepatitis B (CHB) combined with autoimmune hepatitis (AIH).Methods:Clinical manifestations, laboratory examination, imaging, histopathological characteristics, treatment and prognosis of 19 cases diagnosed with CHB combined with AIH followed at the outpatient Department of Gastroenterology of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine during December 2013 to June 2018 were retrospectively analyzed. Paired sample t-test was used before and after treatment for the measurement of normal distribution data. Measurement data of non-normal distribution were expressed as a median (quartile spacing) and Wilcoxon matched-pairs signed rank test was used before and after treatment.Results:Among the 19 cases, 5 were male and 14 were female. The age of onset was 35 to 63 years, and the average age was 47.10 ± 8.76 years. There were 12 cases diagnosed with CHB before AIH, 5 cases diagnosed with AIH before CHB, and 2 cases diagnosed with AIH and CHB at the same time. After the definite diagnosis of CHB combined with AIH, nucleoside (acid) analogues (antiviral against hepatitis B virus) combined glucocorticoid therapy were given, and azathioprine or mycophenolate mofetil (immunosuppressant) was added according to the intrahepatic inflammation (inflammation graded at G3 and above) and leukocyte conditions. The duration of treatment varied between 2 weeks to 16 (median treatment duration of 6 weeks), except for one case who was just diagnosed and followed up. Biochemical indicators and immunoglobulin of the remaining 18 cases before and after treatment was significantly decreased, and the differences were statistically significant ( P < 0.05), with HBV DNA < 20 copies/ml. Conclusion:CHB combined with AIH diagnosis can be easily missed. Therefore, it requires comprehensive diagnosis combined with clinical characteristics, autoantibodies, and immunoglobulin levels with special emphasis on pathological characteristics of liver tissue. Anti-HBc-positive patients using immunosuppressant should be carefully monitored for HBV DNA and anti-HBV treatment should be given if necessary.
