【摘要】 自身免疫性肝炎（AIH）相关亚急性肝衰竭合并甲状腺功能亢进症在临床上较为罕见，两者共存时免疫紊乱与代谢异常相互叠加可显著加重肝损伤，导致病情进展迅速、治疗难度大、病死率高。本文报道1例52岁女性患者，因“腹痛伴肝功能异常”入院，经实验室检查并结合肝穿刺病理最终确诊为AIH相关亚急性肝衰竭合并甲状腺功能亢进症。在常规保肝及抗感染治疗效果不佳且抗甲状腺药物、放射性¹³¹I及外科手术暂不适宜的背景下，经病情评估后，及早实施糖皮质激素联合人工肝（双重血浆分子吸附系统联合血浆置换模式）治疗，为后续安全实施¹³¹I序贯治疗创造条件。本病例提示，在AIH合并甲状腺功能亢进症并进展为肝衰竭的复杂情境下，通过糖皮质激素与人工肝的联合应用、¹³¹I治疗，可构建“稳定病情-桥接过渡-序贯根治”的临床管理路径，为类似多系统免疫共病患者的救治提供参考。更多还原

【Abstract】 Autoimmune hepatitis（AIH）-related subacute liver failure complicated by hyperthyroidism is a rare clinical occurrence.When the two coexist,the superimposition of immune disorders and metabolic abnormalities can significantly aggravate liver injury,leading to rapid disease progression,high treatment difficulty and a high mortality rate.This article reports a 52-year-old female patient who was admitted to the hospital due to "abdominal pain accompanied by abnormal liver function".After laboratory tests and combined with liver puncture pathology,the patient was finally diagnosed with AIH-related subacute liver failure complicated with hyperthyroidism.Against the backdrop of ineffective conventional liver-protecting and anti-infection treatments,and the temporary insuitability of antithyroid drugs,radioactive ¹³¹I and surgical operations,after the assessment of the condition,glucocorticoid combined with artificial liver（dual plasma molecular adsorption system combined with plasma exchange mode） treatment was implemented as early as possible to create conditions for the subsequent safe implementation of ¹³¹I sequential treatment.This case suggests that in a complex situation where AIH is combined with hyperthyroidism and progresses to liver failure,through the combined application of glucocorticoids and artificial liver,as well as ¹³¹I treatment,a clinical management pathway of "stabilizing the condition-bridging transition-sequential radical cure" can be established,to provide a reference for the treatment of patients with similar multi-system immune comorbidities.更多还原