目的 观察丁二磺酸腺苷蛋氨酸辅助治疗原发性胆汁性胆管炎临床疗效.方法 选取2018年1月至2019年12月原发性胆汁性胆管炎初治患者50例,随机分2组,对照组予熊去氧胆酸治疗,观察组予熊去氧胆酸联合丁二磺酸腺苷蛋氨酸治疗,丁二磺酸腺苷蛋氨酸静脉注射两周后改口服治疗,总疗程24周.治疗前及治疗6个月、1年时检测肝功能和肝脏弹性.结果 治疗6个月爱媛标准判断疗效,观察组应答为23例(92.0％),显著高于对照组17(68.0％),差异有统计学意义(P=0.034);治疗1年巴塞罗那标准判断疗效,观察组应答为20例(80.0％),高于对照组17(68.0％),但差异无统计学意义(P=0.333),治疗后6个月和1年,观察组肝弹性测定值为[(6.6±2.5)kPa,(6.8±3.0)kPa],低于对照组[(6.8±3.0)kPa,(7.4±2.7)kPa],但差异无统计学意义.两组均无严重不良反应.结论 丁二磺酸腺苷蛋氨酸辅助治疗原发性胆汁性胆管炎近期临床效果显著.

目的 筛选原发性胆汁性胆管炎(PBC)患者无创肝硬化诊断敏感指标.方法 收集2011—2020年在首都医科大学附属北京佑安医院住院确诊为PBC的患者380例.常规电子胃镜、血常规、凝血、肝功能及B超检查,瞬时弹性扫描仪(FibroScan)测定肝脏硬度,根据肝穿及临床诊断分为肝硬化组166例和非肝硬化组214例,比较分析两组指标的差异.随机按8:2比例分为模型组和验证组,通过模型组筛选出敏感指标,应用随机森林法建立无创肝硬化诊断模型,然后使用验证组患者验证其诊断效果.结果 (1)筛选出红细胞比容(HCT)、红细胞计数、肝脏硬度、胆碱酯酶(CHE)、尿酸、天冬氨酸氨基转氨酶-丙氨酸转氨酶比值(AAR)、胆固醇(CHO)、血小板计数、凝血酶原活动度9个对PBC肝硬化影响效力最高的指标,采用随机森林方法建立模型,ROC曲线下面积为89.6％.9个指标中HCT影响权重最高.(2)肝硬化组HCT[(29.8±7.1)％]较非肝硬化组的(35.4±6.6)％明显降低,差异有统计学意义(P<0.001).结论 HCT可以作为PBC患者无创肝硬化诊断模型中重要的指标之一,它无创且极易获得,检测难度低,外推性好,可能使部分患者避免肝活检.

目的 探讨原发性胆汁性胆管炎(primary biliary cholangitis,PBC)患者血清中免疫球蛋白G(immunoglobulin G,IgG)亚型的分布特征.方法 选取2018年5月至2019年3月首都医科大学附属北京佑安医院收治的28例PBC患者、29例自身免疫性肝炎(autoimmune hepatitis,AIH)患者及同期30名健康体检者.散射比浊法检测血清IgG1、IgG2、IgG3、IgG4水平;分析IgG亚型水平及IgG亚型占总IgG水平百分比的分布特征.结果 IgG1、IgG1/IgG、IgG3、IgG3/IgG在3组中的分布差异均有统计学意义(P＜0.05),其中AIH组以IgG1、IgG1/IgG升高为特点,PBC组以IgG3、IgG3/IgG升高为特点.PBC组的IgG3与IgM水平呈显著正相关(r=0.709,P＜0.001).PBC患者中IgG3水平正常组与IgG3升高组抗线粒体抗体(AMA)的分布差异有统计学意义(x2=6.910,P=0.030),IgG3升高组的AMA-M2显著高于IgG3正常组[662.4(418.8,794.4) RU/ml比199.5(25.0, 308.9)RU/ml,Z=30.000,P=0.003].结论 PBC患者的IgG水平显著升高,且IgG抗体亚型以IgG3升高为主,IgG3升高可能与高滴度AMA和AMA-M2抗体有关.

目的 探讨药物性肝损伤(DILI)患者临床分型的变化及其组织病理学特征.方法 2018年8月～2019年8月入院临床诊断为肝细胞型DILI患者43例,在入院治疗2周后行肝穿活检,在病理学检查当日再次根据临床指标确定临床分型,观察组织病理学特征.结果 43例临床诊断的肝细胞型DILI患者在肝穿时血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)和总胆汁酸(TBA)水平已显著降低,其R值较入院时也显著下降(19.6±13.6对3.29±3.26),差异具有统计学意义(P<0.05);组织病理学检查诊断急性炎症型21例,炎症淤胆型22例;在入院时,急性炎症型与炎症淤胆型患者血清ALT、AST、TBIL、ALP和GGT水平无显著性差异(P>0.05),仅急性炎症型患者R值显著小于炎症淤胆型(13.8±6.2对25.5±16.5,P=0.004),血清TBA水平显著低于炎症淤胆型(61.0±60.8μmol/L对115.3±80.9μmol/L,P=0.017);入院时诊断为肝细胞型DILI的43例患者在肝穿时仅9例符合肝细胞型临床分型;经ROC曲线分析,以R值等于14.9为截断点,其曲线下面积(AUC)为0.708,具有一定的诊断意义.结论 药物性肝损伤的临床分型会随着病情的变化而呈动态变化,入院时以较高的R值诊断胆汁淤积具有一定的指导意义,值得进一步观察.

目的 分析原发性干燥综合征(pSS)合并自身免疫性肝病(ALD)的肝损伤临床特征,为pSS肝损伤的诊治提供借鉴.方法 回顾性分析我院2010年1月—2018年6月收治98例以肝损伤就诊的pSS患者98例的一般资料,按照合并不同ALD类型分为合并原发性胆汁性胆管炎(PBC)组30例,合并自身免疫性肝炎(AIH)组12例,单纯pSS组56例.结果 AIH组年龄显著低于PBC组和pSS组,PBC组瘙痒症状、碱性磷酸酶、抗线粒体抗体阳性率显著高于AIH组和pSS组(P<0.05).3组丙氨酸转氨酶、天门冬氨酸氨基转氨酶、总胆红素、直接胆红素、γ谷氨酰转肽酶、总胆汁酸、血清白蛋白、干燥综合征A抗体、干燥综合征B抗体阳性率比较差异无统计学意义(P>0.05).结论 pSS肝损伤伴有ALD是pSS的特殊类型,综合分析患者临床和实验室检查有助于不同类型pSS肝损伤的诊断和选择治疗方案.

首先分析目前传染病教学中面临的困境,如学生学习兴趣不高、教学时间短、任务重,教材相对滞后,学生很难在学习过程中见到所有大纲规定需要学习的病种,单纯采用传统教学方式,不利于学生的长期发展.其次介绍本课题组利用我院现有的人工智能科研资料库、教学病例资料库,采用多种教学方法结合的教学方式,在传染病教学方面的应用体会.先比较了传统授课方式、案例教学法、以问题为基础教学法、以图为基础教学法、翻转课堂、雨课堂的特点,最后介绍了如何对这些方法进行结合使用,以及教学效果.

ObjectiveTo investigate the clinical effect and safety of magnesium isoglycyrrhizinate in the treatment of autoimmune-like drug-induced liver injury. MethodsA total of 53 patients with autoimmune-like drug-induced liver injury who were hospitalized in Beijing YouAn Hospital, Capital Medical University, from July 2016 to January 2019 was enrolled as observation group, and 50 patients with drug-induced liver injury who had no autoimmune symptoms were enrolled as control group. All patients were given magnesium isoglycyrrhizinate (200 mg/d) for 4 weeks. Liver function and immunological indices were observed before and after treatment, and adverse reactions were recorded for all patients. Liver function was followed up every month for 6 months after treatment. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsAfter treatment, the observation group had significant reductions in alanine aminotransferase (ALT) ［35.4 (29.2-42.0) U/L vs 289.0 (226.6-460.3) U/L, Z=-8.661, P＜0.001］, aspartate aminotransferase (AST) ［46.3 (15.6-183.5) U/L vs 306.3 (32.2-589.8) U/L, Z=-5.271, P＜0.001］, gamma-glutamyl transpeptidase (GGT) ［77.0 (53.2-183.2) U/L vs 129.0 (77.8-232.5) U/L, Z=-3.437, P=0.001］, alkaline phosphatase (ALP) ［83.1 (64.9-83.1) U/L vs 119.4 (104.9-146.9) U/L, Z=-3.485, P＜0.001］, and total bilirubin (TBil) (27.5±10.3 μmol/L vs 59.7±18.6 μmol/L, t=6.673, P＜0001), and the control group also had significant reductions in ALT ［331 (14.9-106.4) U/L vs 300.6 (206.8-679.5) U/L, Z=-8.232, P＜0.001］, AST ［44.1 (20.8-151.6) U/L vs 321.7 (36.2-5532) U/L, Z=-3.549, P＜0.001］, GGT ［82.7 (50.6-168.5) U/L vs 133.5 (72.2-254.2) U/L, Z=-2.364, P=0.018］, ALP ［87.6 (74.3-139.4) U/L vs 128.0 (106.3-201.4) U/L, Z=-4.303, P＜0.001］, and TBil (23.8±10.9 μmol/L vs 58.3±19.8 μmol/L, t=-8.450, P＜0.001); however, there were no significant differences between the two groups after treatment (P＞005). For the observation group, the level of IgG decreased from 15.8±3.2 g/L before treatment to 14.2±2.0 g/L after treatment, and among the 22 patients with elevated IgG (＞16 g/L) before treatment, 18 (81.8%) had an IgG level back to normal. Among the 36 patients with positive anti-nuclear antibody, 19 (52.7%) achieved negative conversion. No serious adverse reaction was observed in the two groups. In terms of the patients who underwent liver biopsy, the observation group had a significantly higher proportion of patients with neutrophil and/or eosinophil infiltration than the control group ［53.1% (17/32) vs 17.5% (3/17), χ2=5.785, P=0.016］. ConclusionMagnesium glycyrrhizinate is safe and effective in the treatment of autoimmune-like drug-induced liver injury and can thus be selected as an alternative treatment method in clinical practice.

目的:观察大黄利胆胶囊对熊去氧胆酸(UDCA)经治的原发性胆汁性胆管炎患者的治疗效果.方法:经6个月UDCA治疗后以爱媛标准判断疗效不佳的患者60例,随机分为观察组33例,加用大黄利胆胶囊;对照组27例患者继续使用UDCA.6个月后复查患者肝功能及免疫球蛋白指标,按巴塞罗那标准判断UDCA疗效.结果:口服UDCA 1年后,观察组患者γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)较6个月时明显下降,与对照组比较,差异有统计学意义(P ＜0.05);观察组患者UDCA应答率为63.6％,显著高于对照的37.0％.结论:以爱媛标准判断UDCA疗效不佳患者联合应用大黄利胆胶囊,可提高患者UDCA的应答率.

传染病见习教学目前存在较多问题:教学资源、时间均有限,教学任务重、患者配合度差、见习难度大等.这导致了传统的见习方法在传染病教学中存在多种不足.如何激发学生学习的兴趣和最大程度地提高课堂质量是传染病教学一直面临的问题.为改善传统教学法的不足,解决传染病教学中存在的各种问题,课题组将"翻转课堂"的模式引入课堂,采用"微课"为载体,结合以往在原发性胆汁性肝硬化患者及家属健康宣教中的经验,探索"翻转课堂"在传染病教学中的实施方案.研究结果证实基于典型病例进行翻转课堂教学的方法,提高了学生的学习兴趣和学习效率,可作为传染病临床教师提高课堂教学效率的选择方法.

目的 通过对北京佑安医院进修医师基本情况的分析,总结进修医师特点及进修教育管理存在的问题,探讨加强进修医师教学管理的对策和方法.方法 对2013年3月—2018年9月来院的进修医师资料进行分类统计分析,了解进修医师的基本情况,包括性别、年龄、职称、进修亚专业、单位来源等.结果 近6年来,我院进修人数以2014年最多,达127人;2018年最少为49人;其男女比例、年龄、职称比较无明显差异.进修人数最多的亚学科是依次是肝病156人次(28.2％)、肝癌介入112人次(20.3％)、人工肝75人次(13.6％)、传染病(含艾滋病)72人次(13.0％)和重症肝病(含ICU)70人次(12.7％);进修时间多为6个月.结论 加强重点学科和师资队伍建设,优化课程设置是促进专科特色医院进修医师教学工作的重要手段.

ObjectiveTo investigate the single nucleotide polymorphism (SNP) and serum expression of interferon-gamma-induced protein 10 (IP-10) in patients with drug-induced liver injury accompanied by autoimmune phenomena (AI-DILI). MethodsA total of 168 patients with drug-induced liver injury (DILI) who were diagnosed and treated in Beijing YouAn Hospital, Capital Medical University, from October 2016 to June 2019 were enrolled and divided into AI-DILI group(n=72) and non-AI-DILI group(n=96). The SNP of IP-10 rs56061981 locus was detected and the serum level of IP-10 was measured. The two groups were compared in terms of IP-10 level and SNP genotype, and their association with the development of AI-DILI was analyzed. Allele frequency was calculated based on genotype results, and the chi-square test was used for Hardy-Weinberg equilibrium analysis. The t-test and the Mann-Whitney U test were used for comparison between two groups; a repeated measures analysis of variance was used for comparison between different time points; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Pearson correlation analysis was used to investigate correlation. The receiver operating characteristic (ROC) curve was used to analyze the value of baseline IP-10 level in predicting AI-DILI. ResultsThere was a significant difference in the positive rate of autoantibody between the AI-DILI group and the non-AI-DILI group (91.67% vs 12.5%, χ2= 103.8, P＜0.05). Compared with the non-AI-DILI group, the AI-DILI group had significantly higher distribution frequency of CC genotype (77.78% vs 62.50%, χ2=4.592, P=0.03) and frequency of C allele (8611% vs 72.92%, χ2=4.41, P=0.04). The AI-DILI group had a significantly higher baseline IL-10 level than the non-AI-DILI group (627.99±198.07 pg/ml vs 378.13±218.45 pg/ml, t=7.34, P＜0.05), and baseline IL-10 level was positively correlated with baseline aspartate aminotransferase level and AIH score (r=0.67 and 079, both P＜0.05). At the optimal cut-off value of 527.03 pg/ml, baseline IP-10 level had a sensitivity of 0.846, a specificity of 0867, and an area under the ROC curve of 0.832 in predicting AI-DILI. CC genotype combined with a baseline IP-10 level of ≥52703 pg/ml had a positive predictive value of 92.84% and a negative predictive value of 86.33% in predicting the development of AI-DILI. ConclusionCC genotype of IP-10 rs56061981 is associated with the development of AI-DILI and affects the serum expression of IP-10, and the combination of CC genotype and IP-10 expression has a high value in predicting AI-DILI.

目的 探讨应用熊去氧胆酸(UDCA)治疗原发性胆汁性胆管炎患者血清甲状腺激素水平的变化.方法 2016年1月～2017年6月我院治疗的原发性胆汁性胆管炎患者70例和原发性胆汁性肝硬化患者95例,另选20例健康人作为对照组.给予患者UDCA治疗3月,检测治疗前后血清甲状腺激素水平变化.结果 在治疗3个月末,两组患者肝功能指标得到改善,除胆管炎患者血清ALP和GGT水平仍显著高于肝硬化患者外,其他肝功能指标比较,差异无统计学意义(P>0.05);治疗前,胆管炎患者血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平分别为1.6±0.2 nmol/L、3.2±0.4 pmol/L、95.6±28.7 nmol/L和10.3±3.6 pmol/L,肝硬化患者分别为1.1±0.2 nmol/L、3.0±0.3 pmol/L、88.2±26.7 nmol/L和9.7±2.5 pmol/L,均显著低于健康人[分别为(2.5±0.5 nmol/L、4.7±0.8 pmol/L、115.7±31.6 nmol/L和13.8±4.1 pmol/L,P<0.05],两组患者血清促甲状腺素(TSH)水平与健康人比,差异无统计学意义[分别为(2.9±0.5 mIU/L和2.9±0.7 mIU/L对3.3±0.6 mIU/L,P>0.05];在治疗3个月末,胆管炎患者血清TT3、FT3、TT4和FT4水平分别为2.4±0.6 nmol/L、4.5±0.8 pmol/L、108.2±36.2 nmol/L和12.9±3.5 pmol/L,较治疗前显著上升,已与健康人无统计学差异(P>0.05),而肝硬化患者血清TT3、FT3、TT4和FT4水平分别为1.2±0.3 nmol/L、3.4±0.4 pmol/L、93.7±29.8 nmol/L和9.9±3.1 pmol/L,无明显改善,仍显著低于健康人(P<0.05).结论 原发性胆汁性胆管炎患者经熊去氧胆酸治疗后,血清甲状腺激素水平可获得改善,因此应该早期诊断、早期治疗.

自身免疫性肝炎(AIH)是一种病因未明的慢性肝脏炎症性疾病,目前认为遗传和环境因素都参与AIH的发生.环境暴露对AIH发病的影响是至关重要的.自身免疫生态学是研究个体与环境之间的相互作用,以及个体与环境之间失平衡的发生及对自身免疫性疾病发展的促进机制的学科.就近年来自身免疫生态学在AIH发病机理研究进展作一综述.

肠道细菌过度生长、肠道菌群变化、细菌及其产物的易位与胆汁酸代谢的相互作用等是多种肝病发生发展的重要共同途径.肝细胞通过门静脉系统持续的暴露于肠道代谢产物及各种抗原抗体之下,某些肠道细菌成分或代谢物可通过“分子模拟”等多个机制启动针对肝细胞的自身免疫机制.因此肠道菌群在自身免疫性肝病,包括自身免疫性肝炎、原发性胆汁性胆管炎和原发性硬化性胆管炎的发生发展及治疗过程中发挥了重要作用,对近年来的相关研究进展进行了阐述和总结.

进修教育是继续医学教育的重要组成部分,医师的进修学习已成为医疗职业培训的重要途径.文章根据北京佑安医院肝病免疫科进修医师培训的实际情况,就自身免疫性肝病亚学科进修培训的培训前调研、课程设置、临床训练、课程评价等方面的经验进行总结,以期能够为进修医师临床分支学科教育的发展提供一定的参考与借鉴.

目的 研究原发性肝癌(PLC)伴恶性腹腔积液(MA)患者腹腔积液、外周血及单个核细胞(PBMC)中可溶性程序性死亡配体-1(sPD-L1)、可溶性细胞毒T淋巴细胞相关抗原-4(sCTLA-4)的表达水平,初步探讨其临床意义.方法 选择2016年5月至2019年5月首都医科大学附属北京佑安医院肝病免疫科收治的189例腹腔积液患者作为研究对象,其中92例伴有MA的PLC患者为A组,97例伴有腹腔积液的肝硬化患者为B组.采用酶联免疫吸附法(ELISA)检测患者腹腔积液及外周血sPD-L1、sCTLA-4的表达水平,并采用聚合酶链反应(PCR)方法检测患者外周血PBMC中PD-L1、CTLA-4 mRNA的表达水平.分析sPD-L1、sCTLA-4联合检测对PLC伴MA的诊断价值.结果 A组患者PBMC中PD-L1、CTLA-4 mRNA表达水平显著高于B组,外周血及腹腔积液中sPD-L1及sCTLA-4表达水平显著高于B组(P<0.05);外周血sPD-L1、sCTLA-4表达水平与外周血PBMC中PD-L1、CTLA-4 mRNA表达水平呈显著正相关(P<0.05);腹腔积液与外周血中sPD-L1、sCTLA-4表达水平呈显著正相关(P<0.05);腹腔积液中sPD-L1与sCTLA-4联合检测诊断PLC伴MA的灵敏度、特异度分别为91.4％、95.2％.结论 PLC患者腹腔积液、外周血及外周血PBMC中PD-L1与CTLA-4的表达与病因密切相关,可以在一定程度上反映不同原因腹腔积液导致的免疫微环境差异,有望成为PLC伴MA诊断及免疫治疗的靶点.

目的 总结应用甲基强的松龙治疗药物性肝损伤(DILI)患者临床和实验室特点,为临床应用激素治疗DILI提供参考.方法 2015年3月～2016年10月诊治的DILI患者21例,在停止损肝药物和护肝治疗后,肝功能损伤加重而给予糖皮质激素治疗.应用SPSS 16.0软件进行统计学分析,对符合正态分布的计量资料应用t检验,对非正态分布的计量资料采用秩和检验,计数资料的比较采用卡方检验.结果 在21例DILI患者中,男性6例,女性15例,平均年龄为(49.3±15.2)岁;急性DILI 12例,慢性DILI 9例;自身抗体阳性17例(81.0％);15例行肝穿病理学检查,自身免疫性肝炎(AIH)简易评分为(3.9±1.2)分,未行肝穿检查患者在不计算病理学计分的AIH简易评分为(3.5±0.8)分;应用甲基强的松龙的剂量为(0.65±0.15)mg·kg-1·d-1,属于中小剂量;激素治疗后血生化指标好转,白细胞计数明显上升;未出现不可控制的感染;在13例随访患者,停用激素后7例出现了病情反复.结论 对护肝治疗不应答的伴有自身抗体阳性的DILI患者,可选择中小剂量、中短疗程的糖皮质激素治疗,但停药后容易病情复发,值得探索停药方法.

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.

ObjectiveTo investigate the value of fumarate hydratase antibody (anti-FH) in the differential diagnosis of autoimmune hepatitis (AIH) and drug-induced liver injury (DILI). MethodsFrom March 2014 to December 2016, 105 patients with AIH who were hospitalized in Beijing You’an Hospital were enrolled as AIH group, and 92 patients with DILI were enrolled as DILI group. A total of 128 healthy individuals were enrolled as control group. ELISA was used to measure the serum level of anti-FH. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A consistency analysis of diagnostic compliance of anti-FH based on the Kappa test. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-FH in the diagnosis of AIH were analyzed. ResultsCompared with the DILI group, the AIH group had significantly higher positive rate of anti-nuclear antibody (72.4% vs 55.4%, χ2 = 6147, P=0.013) and level of IgG ((18.3±6.1) g/L vs (15.2±5.4) g/L, t=-2566, P=0.011)). The AIH group had a significantly higher positive rate of anti-FH than the DILI group and the control group (36.2% (38/67) vs 6.5% (6/92) and 2.3% (3/128), χ2=59.959, P＜0.001). In the diagnosis of AIH, anti-FH had a sensitivity of 36.2%, a specificity of 93.5%, a positive predictive value of 86.4%, and a negative predictive value of 93.5%. ConclusionSerum anti-FH has a certain reference value in the differential diagnosis of AIH and DILI.

目的:观察自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)患者外周血中调节性T淋巴细胞分布特点.方法:回顾性分析2013年1月～2018年1月我科就诊的AIH-PBC OS患者23例,自身免疫性肝炎(AIH)94例,予肝功能、凝血项、免疫球蛋白G、自身免疫抗体和调节性T淋巴细胞(Tregs细胞)水平检测,同时选取健康人20例,予调节性T淋巴细胞检测.结果:OS组患者γ-谷氨酰转肽酶、碱性磷酸酶和免疫球蛋白G水平(分别为166.7±135.6U/L、261.1±201.7 U/L和24.1±10.7g/L)显著高于AIH组(104.1±83.8U/L,149.2±125.6U/L和18.7±6.4g/L)(均P＜0.05);OS组、AIH组患者Treg细胞/辅助性T细胞比值(5.7±2.5％vs.5.7±2.4％)无显著性差异(P＞0.05),但低于健康对照组(7.4±1.4％).结论:AIH-PBC OS与AIH患者均有Tregs细胞比例的下降,可能是AIH-PBC OS免疫发病机制之一.