以骨痛为首发表现的原发性胆汁性胆管炎1例

doi:10.6040/j.issn.1671-7554.0.2022.0699

摘要/Abstract

摘要： 目的原发性胆汁性胆管炎(PBC)是一种少见的自身免疫性肝病,也是继发性骨质疏松症的罕见病因。本文通过报告1例以骨痛起病的PBC病例,旨在提高临床医师对该病的重视。方法纳入1例以骨痛为主要表现的老年女性,评估患者实验室检查指标、骨密度、骨骼X线影像特点,并通过复习文献,总结PBC合并骨质疏松症的临床特点。结果患者为61岁女性,双髋、双膝疼痛1年余,双能X线骨密度检查提示骨质疏松症。患者无乏力、皮肤瘙痒、黄染等胆道梗阻表现,肝功示胆管酶γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)升高, 抗线粒体抗体Ⅱ型(AMA-M2)阳性,提示患者为PBC导致的继发性骨质疏松症。结论 PBC临床表现隐匿,以骨痛、骨质疏松症起病少见。骨质疏松症患者如合并胆管酶升高、AMA-M2阳性,应考虑该病可能。

关键词: 原发性胆汁性胆管炎, 继发性骨质疏松症, 骨痛, 双膦酸盐

Abstract: Objective Primary biliary cholangitis(PBC)is a rare autoimmune liver disease, which is one of the rare causes of secondary osteoporosis. In this paper, we will report a case of PBC with bone pain as the main manifestation, in order to arouse clinicians attention to this disease. Methods A case of elderly women with bone pain as the main manifestation was enrolled, and the results of laboratory examinations, bone mineral density and X-ray image of bones were evaluated. The clinical characteristics of PBC with osteoporosis were summarized by reviewing the literature. Results The patient was a 61-year-old female with pain in both hips and knees for more than 1 year. Dual-energy X-ray absorptiometry indicated osteoporosis. The patient showed no symptoms of biliary tract obstruction such as fatigue, skin itching, or yellow staining. However, laboratory examinations showed elevated biliary tract enzyme, including gamma-glutamyl transferase(GGT)and alkaline phosphatase(ALP). Her anti-mitochondrial antibody type Ⅱ(AMA-M2)was positive. These results indicated that her osteoporosis was probably caused by PBC. Conclusion The clinical manifestations of PBC are insidious. PBC should be considered in patients with osteoporosis, especially when the bile duct enzymes are elevated and AMA-M2 is positive.

Key words: Primary biliary cholangitis, Secondary osteoporosis, Bone pain, Bisphosphonates

中图分类号:

R575.7

陈诗鸿,姜冬青,庄向华,李晓博,潘喆,孙爱丽,娄能俊,王殿辉,杜娇娇,宋玉文. 以骨痛为首发表现的原发性胆汁性胆管炎1例[J]. 山东大学学报 (医学版), 2022, 60(8): 98-102.

CHEN Shihong, JIANG Dongqing, ZHUANG Xianghua, LI Xiaobo, PAN Zhe, SUN Aili, LOU Nengjun, WANG Dianhui, DU Jiaojiao, SONG Yuwen. Primary biliary cholangitis with bone pain as the main manifestation: a case report[J]. Journal of Shandong University (Health Sciences), 2022, 60(8): 98-102.

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