autoimmune cirrhosis
Introduction
Introduction to autoimmune cirrhosis Autoimmune cirrhosis is mainly caused by autoimmune liver disease, of which autoimmune hepatitis (AIH) is the most. The self-immunity of the human body refers to the righteousness of the human body in terms of Chinese medicine. When the human body is lacking in vitality, the resistance to damp heat and poisonous evils will be weakened, and the poisonous evils will not be excluded from the human body through normal metabolism. The human body is righteous, this autoimmune liver disease can easily develop into autoimmune cirrhosis. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: cirrhosis, cirrhosis, ascites
Cause
Causes of autoimmune cirrhosis
The pathogenesis of autoimmune hepatitis is still unclear. It is currently considered that genetics is the main domestic factor of immune hepatitis in its own region. Genetic susceptibility can affect the discovery of immune response and its clinical manifestations. Human leukocyte antigen and DR. It is an independent risk factor for autoimmune research hepatitis. In addition, working viral infections, drugs and the environment can act as triggers to promote the development of immune hepatitis. Due to defects in immune regulation, the patient's response to autologous hepatocyte antigens is manifested by cell-mediated cytotoxicity and the immune response of hepatocyte surface-specific antigens combined with autoantibodies, and the latter is dominant.
Prevention
Autoimmune cirrhosis prevention
The cause of cirrhosis is complicated, the most common is viral hepatitis. The incidence of viral hepatitis is high in China. Therefore, it is extremely important to prevent viral hepatitis. Pay attention to hygiene, strict disinfection of equipment, strict screening of blood donors, and vaccination against hepatitis vaccine. All are important measures to control drinking, reasonable nutrition, and avoid the use of drugs that damage the liver. It should also be noted that patients with cirrhosis that have been found should be given appropriate protective measures, such as appropriate reduction of labor intensity, prevention of complications, and maintenance of health. And extend life.
Complication
Autoimmune cirrhosis complications Complications cirrhosis cirrhosis ascites
1. Hepatic encephalopathy.
2, upper gastrointestinal bleeding: cirrhosis upper gastrointestinal bleeding, most due to esophagus, gastric varices rupture, but should consider whether complicated with peptic ulcer, acute bleeding erosive gastritis, cardia tear syndrome and other gastric mucosal lesions, The variceal bleeding of varicose veins is mostly caused by rougher and harder or angular food wounds. The esophagus is eroded by acid reflux, severe vomiting, etc., and hematemesis and black stools occur. If the amount of bleeding is small, only black stools, if A large amount of hemorrhage can cause shock. In the case of hepatic ischemia and hypoxia, liver function is often deteriorated. Hemorrhage causes loss of plasma protein, which can lead to the formation of ascites. The blood can be induced in the intestine by bacterial decomposition and ammonia is absorbed by the intestinal mucosa. Sexual encephalopathy can even lead to death, and the original swollen spleen can be reduced or even inaccessible after hemorrhage.
3, infection: due to the body's immune function decline, hypersplenism and the establishment of collateral circulation between the portal vein, increased the chance of pathogenic microorganisms invading the body, it is easy to concurrent with various infections, such as bronchitis, pneumonia, tuberculous peritonitis , primary peritonitis, biliary tract infection and Gram-negative bacilli sepsis, primary peritonitis refers to acute peritoneal inflammation of the peritoneal cavity of patients with cirrhosis, the incidence of 3% to 10%, mostly occurs in a large number The patients with ascites are mostly caused by Escherichia coli. The reason is that the phagocytosis of phagocytic cells is weakened during cirrhosis, the bacteria in the intestines are abnormally propagated, enter the abdominal cavity through the intestinal wall, and the bacteria can be changed due to changes in the structure of the blood vessels inside and outside the liver. Infection caused by collateral circulation or bacterial lymphatic leakage from the subcapsular or hepatic hilum lymph node into the abdominal cavity, clinical manifestations of fever, abdominal pain, abdominal distension, abdominal wall tenderness and rebound tenderness, increased ascites, increased white blood cells Ascites is turbid, and it is exudate or between exudate and leakage. Ascites culture can grow bacteria, and a few patients have no abdominal pain and fever. Manifested as hypotension or shock, refractory ascites and progressive liver failure.
Symptom
Autoimmune cirrhosis symptoms Common symptoms Liver disease Ronggan palm liver dysfunction Liver dysfunction
Autoimmune cirrhosis often manifests as fatigue, jaundice, hepatosplenomegaly, itchy skin and insignificant weight loss. After the disease progresses to cirrhosis, ascites, hepatic encephalopathy, and esophageal varices bleeding may occur. Patients with autoimmune hepatitis are also often associated with extra-hepatic systemic immune diseases, most commonly thyroiditis, ulcerative colitis. Laboratory tests showed that gamma globulin was most prominent, mainly igg, which was generally more than twice the normal value. Liver function tests serum bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase can be elevated, serum albumin, cholesterol ester decreased, reflecting the characteristics of autoimmune hepatitis with hepatocyte damage.
In clinical research, Chinese medicine practitioners found that this part of the patients mainly showed fatigue, anorexia, abdominal distension, discomfort, dark yellow urine, low fever, dry mouth, dry throat, dizziness, insomnia, insomnia, weak waist, stool Dry, female patients may have irregular menstruation. The body color was dull, the spleen was enlarged, and the tongue was dark red or had ecchymoses. TCM syndrome differentiation is mostly qi and yin deficiency, blood stasis, dampness and heat.
Examine
Autoimmune cirrhosis
1, blood routine: in the spleen hyperfunction, the whole blood cells decreased, leukopenia, often below 4.0 × 109 / L (4000), more than 50 × 109 / L (50000) platelets, most cases showed normal cell anemia A few cases can be large cell anemia.
2, urine test: urinary bilirubin / urinary biliary positive when there is jaundice.
3, routine examination of ascites: ascites is leakage, density below 1.018, negative for Lee's reaction, cell number below 100/mm3, protein quantitation less than 25g / L.
4, liver function test: liver function is very complicated, many clinical tests, but it is difficult to reflect all functional status, a variety of test results need to be combined with clinical performance and other tests comprehensive analysis.
Diagnosis
Diagnosis and diagnosis of autoimmune cirrhosis
1. Primary biliary cirrhosis and AIH have similarities in clinical symptoms and laboratory tests, but more common in middle-aged women, with fatigue, jaundice, skin itching as the main performance, liver function test alkaline phosphatase, -glutamyl transpeptidase was significantly increased, serum total cholesterol, triglyceride, low-density lipoprotein increased, and immunoglobulin was highlighted by IgM. Serum anti-mitochondrial antibody M2 is a disease-specific antibody, pathologically appearing biliary epithelial damage inflammation, bile duct disappearance and granuloma in the portal area contribute to the diagnosis of the disease.
2. Primary sclerosing cholangitis is characterized by extensive inflammation and fibrosis of the intrahepatic and extrahepatic biliary system. It is more common in young and middle-aged men, often with ulcerative colitis, and 84% of patients are positive for ANCA, but not specific. . Cholangiography can be seen in the intrahepatic and extrahepatic bile duct stenosis and expansion and bead-like changes, the diagnosis needs to exclude tumors, stones, surgery, trauma and other secondary causes, the lesion only involving the intrahepatic small bile duct diagnosis requires histological examination, typically changed to fiber Sexual cholangitis.
3. Acute and chronic viral hepatitis can also occur with hyperglobulinemia and circulating autoantibodies, but the antibody titer is low and the duration is short. It is helpful to detect serum viral antigens and antibodies.
4. Alcoholic steatohepatitis has a history of drinking, mostly elevated serum IgA levels, although ANA and SMA can be positive, but the general titer is low, and few anti-LKM1 and PANCA positive.
5. Drug-induced liver damage often has a history of taking special drugs. After stopping the drug, the liver abnormality can completely disappear. Generally, it will not develop into chronic hepatitis. Histopathological examination reveals necrosis and eosinophil infiltration in the lobules or acinar zone. Simple cholestatic, granulomatous hepatitis, hepatocyte steatosis, etc. can indicate drug-induced liver damage. However, it should be noted that some drugs can induce autoimmune reactions, clinical manifestations and laboratory tests are very similar to AIH, and the identification depends on pathology and the relief or recovery of the disease after stopping the drug.
