Beisel Claudia, Weiler-Normann Christina, Teufel Andreas, Lohse Ansgar W
Claudia Beisel, Christina Weiler-Normann, Ansgar W Lohse, Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
World J Gastroenterol. 2014 Sep 21;20(35):12662-7. doi: 10.3748/wjg.v20.i35.12662.
Liver test abnormalities have been described in up to 60% of patients with systemic lupus erythematodes (SLE) at some point during the course of their disease. Prior treatment with potentially hepatotoxic drugs or viral hepatitis is commonly considered to be the main cause of liver disease in SLE patients. However, in rare cases elevated liver enzymes may be due to concurrent autoimmune hepatitis (AIH). To distinguish whether the patient has primary liver disease with associated autoimmune clinical and laboratory features resembling SLE - such as AIH - or the elevation of liver enzymes is a manifestation of SLE remains a difficult challenge for the treating physician. Here, we present six female patients with complex autoimmune disorders and hepatitis. Patient charts were reviewed in order to investigate the complex relationship between SLE and AIH. All patients had coexisting autoimmune disease in their medical history. At the time of diagnosis of AIH, patients presented with arthralgia, abdominal complaints, cutaneous involvement and fatigue as common symptoms. All patients fulfilled the current diagnostic criteria of both, AIH and SLE. Remission of acute hepatitis was achieved in all cases after the initiation of immunosuppressive therapy. In addition to this case study a literature review was conducted.
在系统性红斑狼疮（SLE）患者病程的某个阶段，高达60%的患者曾出现肝功能检查异常。既往使用具有潜在肝毒性的药物或病毒性肝炎通常被认为是SLE患者肝病的主要原因。然而，在罕见情况下，肝酶升高可能是由于并发自身免疫性肝炎（AIH）。区分患者是患有具有类似SLE的自身免疫性临床和实验室特征的原发性肝病（如AIH），还是肝酶升高是SLE的一种表现，这对主治医生来说仍然是一项艰巨的挑战。在此，我们介绍6例患有复杂自身免疫性疾病和肝炎的女性患者。回顾患者病历以研究SLE与AIH之间的复杂关系。所有患者病史中均存在共存的自身免疫性疾病。在诊断AIH时，患者表现出关节痛、腹部不适、皮肤受累和疲劳等常见症状。所有患者均符合当前AIH和SLE的诊断标准。在开始免疫抑制治疗后，所有病例的急性肝炎均实现缓解。除了本病例研究外，还进行了文献综述。
