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Abstract: The patient, a 39-year-old female, came to our hospital with an unexplained liver injury found. After pathological examination, a clear diagnosis was finally made: primary biliary cholangitis, a form of autoimmune liver disease. After learning the cause of the disease, the patient’s heart finally fell to the ground, because autoimmune liver disease has a great relationship with heredity and the environment, and is not contagious. After drug treatment, the patient’s liver function was normal and her condition was basically stable.
Basic information】Female, 39 years old
Disease Type】Autoimmune liver disease (primary biliary cholangitis)
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2022
【Treatment plan】Medication (ursodeoxycholic acid capsule, polyene phosphatidylcholine capsule, silymarin capsule)
【Treatment period】Conventional liver protection for 1 month, long-term oral ursodeoxycholic acid capsules
Treatment effect] Liver function is normal and the condition is basically stable
I. Initial consultation
A 39-year-old female patient was found to have abnormal liver function during a physical examination, after which the liver function index fluctuated repeatedly, and remained abnormal after a period of liver protection and rest. This patient had no history of alcohol consumption, was well-proportioned, and did not have problems such as dyslipidemia, which did not appear to be caused by fatty liver. In combination with the fact that she was a middle-aged woman, the possibility of autoimmune liver disease was considered not to be excluded.
In further detailed examination, the patient underwent liver autoantibodies, ANA profile, and immunoglobulins and other related laboratory tests, which showed positive antinuclear antibodies and elevated immunoglobulin G. The preliminary diagnosis of autoimmune liver disease was made. Since there are many different pathological types of autoimmune liver disease, the patient needed to undergo pathological puncture biopsy to clarify the pathological types, and the final pathological diagnosis: primary biliary cholangitis.
II. Treatment history
The patient’s anxiety was reduced after the diagnosis was clarified, and after communicating with the patient, the patient expressed his willingness to follow the medical prescription for treatment. According to the patient’s liver function, he was given a liver-protective treatment plan: ursodeoxycholic acid capsule, polyenylated phosphatidylcholine capsule and silymarin capsule, which can reduce liver cell damage and promote bile secretion. During the initial 2 weeks of liver-protective treatment, the patient’s transaminases had reached normal, but the decrease of glutamyl transpeptidase was not obvious and fluctuated at the original baseline level. Silymarin capsules and polyenylphosphatidylcholine capsules were then discontinued and the patient was put on ursodeoxycholic acid capsules alone to consolidate treatment. Liver function was then monitored and liver ultrasound was repeated every 3 months.
III. Treatment effect
After drug treatment, the patient’s indexes improved but were not completely normal. Later, the treatment plan was adjusted, and at the 3-month recheck, the liver function was normal and in a basically stable state. During this period, the patient had no obvious discomfort, good appetite and sleep, and could live and work normally. The patient expressed satisfaction with the treatment effect, and was advised to review liver function, ANA spectrum, liver ultrasound or CT every 3 months to 6 months, and to consult the doctor immediately if he is not feeling well.
IV. Precautions
After receiving treatment, the patient’s condition is basically stable, and as a doctor, we are sincerely happy for the patient and his family. Since primary biliary cholangitis is a type of autoimmune liver disease, if you are stressed and emotionally tense, it may affect your autoimmunity and lead to aggravation of the disease. Therefore, you should relax your mind and adjust your lifestyle after discharge, you can choose to plant flowers and read books to calm your mind; in addition, you should avoid straining and exercise moderately. Patients with liver disease should not drink alcohol and advocate a balanced and nutritious diet.
V. Personal insight
In clinical practice, we can encounter many patients who have unexplained liver injury, and the cause of liver injury is still not clear after systematic examination, which makes it difficult for future treatment and disease prediction. In this case, it is recommended to perform a liver puncture pathology biopsy, which can be used to systematically grade the severity of liver injury through microscopic manifestations and special staining, and bring some help to patients for a clear diagnosis.