| OBJECTIVE:The study analyzed clinical characteristics of 156 patients with Autoimmune hepatitis(AIH)in Qilu Hospital of Shandong University,and explored the AIH clinical features of AIH group and overlap syndrome(OS)group,cirrhosis group and non-cirrhosis group,with gallbladder stone group and non-gallbladder stone group,immunosuppressant treatment group and non-immunosuppressant treatment group in order to further understand of autoimmune hepatitis and improve early diagnosis and standardized treatment.METHODS:Retrospective analysis of general conditions,clinical manifestations,complications,routine blood tests,coagulation indicators,blood biochemistry,autoantibodies,serum immunoglobulin,imaging examination,histopathology and treatment of 156 patients with AIH in Qilu Hospital of Shandong University from January of 2011 to December 2019.According to primary biliary cholangitis(PBC)(AIH group and AIH-PBC group),cirrhosis(cirrhosis group and non-cirrhosis group),gallbladder stones(gallbladder stones group and non-gallbladder stones group)and treatment(immunosuppressant treatment group and non-immunosuppressant treatment group),the patients were divided two groups and were retrospectively analyzed.Results:1.Of the 156 patients with AIH in this study,there were 22 males(14.1%)and 134 females(85.9%),the ratio of male to female was 1/6,the mean age of all patients was(51.8±13.7)years,a peak incidence at 51-60 years.The main clinical manifestations included fatigue,anorexia,nausea,abdominal distension,jaundice,and abdominal pain.Some patients found abnormal liver function without clinical symptoms when taking physical examinations or other conditions.In addition,other rare symptoms include splenomegaly,ascites,lower extremity edema,pruritus,dry eyes/mouth.2.The study had 68 cases with extrahepatic autoimmune diseases including Sjogren’s Syndrome in 19 cases(27.9%),Hashimoto’s Thyroiditis in 12 cases(17.6%),Rheumatoid Arthritis in 11 cases(16.2%),Diabetes in 8 cases(11.8%),Systemic Lupus Erythematosus in 6 cases(8.8%),Connective Tissue Disease in 4 cases(5.9%),Sensitization Dermatitis in 3 cases(4.4%),psoriasis in 2 case(2.9%),Systemic Sclerosis in 1 case(1.5%),Chronic Atrophic Gastritis in 1 case(1.5%),Autoimmune Hemolytic Anemia in 1 case(1.5%).75 cases were with non-autoimmune diseases,including Cholecystolithiasis in 32 cases(42.7%),Primary Hypertension in 17 cases(22.7%),Alimentary Tract Hemorrhage in 8 cases(10.7%),Epstein-Barr Virus Infection in 7 cases(9.3%),Coronary Atherosclerotic Heart Disease in 5 cases(6.7%),Hepatic Encephalopathy in 4 cases(5.3%),and Pulmonary Infection in 2 cases(2.7%).3.In this study,the serum biochemical indicators of patients showed that the levels of AST and ALT were elevated,and ALP and GGT were also mildly abnormal,but rarely exceeded the upper limit of the reference value by 5 times.The other indicators were normal.TBil and GLB slightly increased,but ALB decreased slightly.Among them,64 patients underwent immunoglobulin examination,showing a slight increase in IgG.4.Among liver disease-related autoantibodies,ANA was positive in 148 cases(94.9%),ASMA was positive in 31 cases(19.9%),AMA was positive in 23 cases(14.7%),anti SSA antibody was positive in 19 cases(12.2%),anti-gp210 antibody was positive in 14 cases(9.0%),anti-sp100 antibodies was positive in 12 cases(7.7%),anti-u1RNP antibody was positive in 9 cases(5.8%),anti-SSB antibody was positive in 8 cases(5.1%),anti-Sm antibody was positive in 7 cases(4.5%),Parietal Cell Antibodies was positive in 5 cases(3.2%),anti-CCP antibody was positive in 4 cases(2.6%).In addition,anti-dsDNA and anti-Scl-70 antibody respectively had 3 cases(1.9%).Anti-LC-1,and anti-SLA/LP antibody respectively had 1 cases(0.6%).No anti-LKM-1 antibody and p-ANCA were found.5.156 patients underwent abdominal ultrasound,CT or enhanced CT,abdominal MRI and other examinations found 59 cases of splenomegaly,48 cases of cirrhosis,32 cases of gallbladder stones,25 cases who had diffuse liver lesions did not reach the level of cirrhosis,23 cases of ascites.12 cases had liver enlargement,6 cases had portal hypertension,and 40 cases were abnormal on imaging examination.6.Of the 156 AIH patients in this study,15 cases(9.6%)underwent liver biopsy.The main manifestations are interface hepatitis,lymphocyte and plasma cell infiltration in the portal area.Some cases showed bile duct injury.7.In this study,there were 131 cases with AIH and 25 cases with AIH-PBC overlap syndrome.The main clinical manifestations were fatigue,jaundice,anorexia,nausea,greasiness,and splenomegaly.The patients in the AIH-PBC overlap syndrome group were prone to pruritus(P=0.005<0.05).In addition,the levels of ALP and GGT in the AIH-PBC overlap syndrome group were significantly increased(P<0.001).Among the autoantibodies,AMA,anti-gp210 and anti-spl00 are prone to appear in AIH-PBC overlap syndrome group,and the positive rates respectively are 92.0%,48.0%and 20.0%(P<0.05).In the AIH group,the imaging findings were usually mild,38 cases(29.0%)were normal,and 2 cases(8.0%)were normal in AIH-PBC overlap syndrome group(P=0.027<0.05).Cases in AIH-PBC OS group who underwent immunoglobulin M was slightly higher(P<0.05),the level of IgG between the two groups wasn’t different.8.In this study,48 cases were diagnosed with cirrhosis and 108 were non-cirrhotic.Cases in cirrhosis group were older and were prone to show splenomegaly(p<0.05).Cases in cirrhosis group showed the levels of WBC,HGB,PLT,and PTA were lower than those in the non-cirrhotic group(P<0.05).In addition,the level of ALB in the cirrhotic group was lower(P<0.05),Cases in the cirrhotic group who underwent immunoglobulin G test was slightly higher(P=0.021<0.05),the level of IgM between the two groups wasn’t different.9.In this study,32 AIH patients were with gallbladder stones,and 124 cases without gallbladder stones.The ALP and GGT in gallbladder stones group were slightly elevated(P<0.05).In addition,among gallbladder stones group,6(18.8%)cases were with AIH-PBC overlap syndrome,and 10(31.3%)cases were cirrhosis.Among non-gallbladder stones group,19 cases(15.3%)were with AIH-PBC overlap syndrome,38(30.6%)cases with cirrhosis.The differences between the two groups are not statistically significant.(P>0.05).10.In this study,98 patients were treated with immunosuppressive drugs,mainly monotherapy with hormone therapy.Of the remaining 58 patients who were treated with liver-protective drugs,25 patients refused to use the drug because of concerns about hormone side effects,10 cases due to slight clinical symptoms,8 patients due to liver failure and progressing to the stage of decompensation of cirrhosis with severe complications,and other reasons including peptic ulcers and poor glycemic control.The levels of AST,ALT,and TBil in the immunosuppressive treatment group were higher(P<0.05).Inconclusion:1.AIH mainly affects middle-aged women,usually with chronic onset,complicated clinical manifestations and easy to repeat,and lead to occult onset,and about 1/3 of patients progress to cirrhosis.Some cases lead to acute attack or liver failure and are easily complicated with autoimmune diseases.2.The level of AST and ALT has a higher increase than that of ALP and GGT,and not all patients have a increase in IgG.In addition,autoantibodies are one of the important indicators for diagnosis,and liver histological examination needs to be taken seriously.3.AIH-PBC overlap syndrome is the most common in the feature of transaminase and cholestasis,and elevated IgM is also its characteristic manifestation.4.Some patients are not treated with immunosuppressants because of concerns about drug side effects,so patient education needs to be strengthened to improve treatment compliance. |
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