The prevalence of autoantibodies and autoimmune hepatitis in patients with nonalcoholic fatty liver disease
The prevalence of autoantibodies and autoimmune hepatitis in patients with nonalcoholic fatty liver disease
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DOI：
10.1111/j.1572-0241.2004.30444.x
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发表时间：
2004-07-01
影响因子：
9.8
通讯作者：
Angulo, P
中科院分区：
文献类型：
--
作者：
Adams, LA;Lindor, KD;Angulo, P
目的：非酒精性脂肪性肝病（NAFLD）患者的血清中可能存在自身抗体，尽管其患病率和临床意义尚不确定。我们旨在检查 NAFLD 患者中自身抗体和自身免疫性肝炎的患病率。方法：根据国际 AIH 小组，确定了 225 名经肝活检证实的 NAFLD 患者的抗核抗体 (ANA)、抗平滑肌抗体 (抗 SMA) 和自身免疫性肝炎 (AIH) 的患病率。 结果： 51 名患者 [23% (95% CI 17.3-28.2%)] 血清中存在自身抗体，明显高于一般人群的患病率。 46 名患者 (20%) 存在 ANA，6 名患者 (3%) 存在 SMA，一名患者存在两种抗体。阳性自身抗体与较高的纤维化阶段（p = 0.03）、较高的炎症等级（p = 0.02）和较高的丙种球蛋白水平（p = 0.01）相关。在肝活检之前，51 名自身抗体呈阳性的患者中有 45 名 (88%) 符合“可能”或“明确”AIH 的诊断标准。然而，肝活检后，只有四名患者符合诊断标准。 结论：四分之一的 NAFLD 患者存在常规检测的自身抗体，并且与更严重的组织学损伤相关。大多数自身抗体呈阳性的 NAFLD 患者需要进行肝活检来排除 AIH。
OBJECTIVES: Autoantibodies may exist in serum of patients with nonalcoholic fatty liver disease (NAFLD) although their prevalence and clinical significance is uncertain. We aimed at examining the prevalence of autoantibodies and autoimmune hepatitis among patients with NAFLD.METHODS: Prevalence of antinuclear antibodies (ANA), anti-smooth muscle antibodies (anti-SMA), and autoimmune hepatitis (AIH) based on the International AIH Group were determined in 225 patients with liver biopsy-proven NAFLD.RESULTS: Fifty-one patients [23% (95% CI 17.3-28.2%)] had autoantibodies in serum which is significantly higher than the prevalence in the general population. ANA were present in 46 patients (20%), SMA in 6 (3%), and both antibodies in one patient. Positive autoantibodies were associated with higher fibrosis stage (p = 0.03), higher inflammatory grade (p = 0.02), and higher levels of gammaglobulin (p = 0.01). Prior to liver biopsy, 45 of the 51 (88%) patients with positive autoantibodies fulfilled diagnostic criteria for 'probable' or 'definite' AIH. After liver biopsy, however, only four patients fulfilled diagnostic criteria.CONCLUSIONS: Routinely measured autoantibodies are present in one quarter of patients with NAFLD and are associated with more severe histological damage. Liver biopsy is required to rule out AIH in most NAFLD patients with positive autoantibodies.