High level of persistent liver injury is one of clinical characteristics in treatment-naïve acute onset autoimmune hepatitis: experience in acommunity hospital
High level of persistent liver injury is one of clinical characteristics in treatment-naïve acute onset autoimmune hepatitis: experience in acommunity hospital
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高水平持续性肝损伤是治疗的临床特征之一
DOI：
10.1002/jhbp.319
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
O Yokosuka
中科院分区：
文献类型：
--
作者：
K Fujiwara;Y Fukuda Y,K Seza;M Saito;S Yasui;M Nakano;O Yokosuka
目前还没有诊断急性发作性自身免疫性肝炎（A‐AIH）的金标准。新的组织学特征已被报道，但AIH以外的病因可能显示类似的组织学模式。我们试图确定与其他病因不同的A - AIH应考虑哪些临床特征，以及应将哪些组织学特征应用于诊断。方法分析2001 ~ 2015年社区医院收治的46例非重度A - AIH患者（女性35例，平均年龄55.9±14.2岁）的临床、生化、免疫学和病理特征。结果28%的患者免疫球蛋白G水平正常，28%的患者抗核抗体效价< × 80。肝脏组织学表现为急性型占49%，慢性型占51%。小叶中心坏死/塌陷和/或浆细胞积聚、玫瑰花结形成是A‐AIH的特征。高水平的丙氨酸转氨酶在21例患者中持续存在，这些患者在治疗开始前可以观察到等于或超过4周。结论长期持续高水平的丙氨酸转氨酶可能是考虑A - AIH的临床特征之一。对此类患者应应用组织学诊断特征。应紧急制定诊断A - AIH的指南。
BackgroundThere is, as yet, no gold standard for making the diagnosis of acute onset autoimmune hepatitis (A‐AIH). Novel histological characteristics have been reported, but etiologies other than AIH could show similar histological pattern. We attempted to determine what clinical characteristics we should consider as A‐AIH different from other etiologies, and to whom histological characteristics should be applied for the diagnosis.MethodsClinical, biochemical, immunological and pathological features of 46 patients (35 women, mean age 55.9 ± 14.2 years) with non‐severe A‐AIH admitted to a community hospital between 2001 and 2015 were analyzed.ResultsImmunoglobulin G level was normal in 28%, and anti‐nuclear antibody titer was < × 80 in 28%. Liver histology of 49% showed acute form and 51% chronic one. Centrilobular necrosis/collapse and/or plasma cell accumulation, rosette formation were characteristic for A‐AIH. High levels of alanine aminotranferase persisted in 21 patients who could be observed for equal to or more than 4 weeks before the start of treatment.ConclusionsLong persistence of high levels of alanine aminotransferase would be one of clinical features for considering A‐AIH along with conventional features. Histological diagnostic features should be applied for such patients. Guidelines for diagnosing A‐AIH should be urgently drawn up.