自體免疫性肝炎：一病例報告與文獻回顧

Autoimmune Hepatitis: Report of One Case

本文主要探討一個以免疫抑制劑成功治療的自體免疫性肝炎病例。一名30歲女性病患入院主訴為近三個月來易疲倦和尿液顏色較深。患者有泛血球減少、血中出現抗雙股DNA抗體、多發性關節痛、抗核抗體陽性等表現。我們一度將她視為全身性紅斑狼瘡合併肝臟侵犯。但因其對免疫抑制劑的治療反應良好及未曾出現任何全身性紅斑狼瘡的症狀，又患者雖有抗雙股DNA抗體但效價 甚低、而且出現高效償的抗平滑肌抗體。全身性紅斑狼瘡合併肝臟侵犯及自體免疫性肝炎兩者間的鑑別診斷值得注意， 我們再依自體免疫性肝炎SCORING SYSTEM診斷為自體免疫性肝炎。

A female patient with autoimmune hepatitis was successfully treated with irnmunosupressive medication. This 30 year-old female was hospitalized with the chief complaint of general malaise and dark colored urine for three months. The past history also revealed arthralgia for 1 long time. On admission, laboratory tests showed pancytopenia、positive ANA、and positive anti-dsDNA. Initally the diagnosis was toward a case of SLE complicated with hepatic involvement. However, the characteristic features of autoimmune hepatitis [AIH] including the relatively low titer of anti-dsDNA, and the relatively high titer of smooth muscle antibody favored the diagnosis of AIH. Employing the autoimmune hepatitis scoring system to calculate the points of the patient was in favor of the diagnosis of autoimmune hepatitis.