Objective To investigate the chronological changes in the clinical features of autoimmune liver disease( AILD) at initial diagnosis,presence or absence of complications of liver cirrhosis at initial diagnosis,initial diagnostic methods,and results of liver biopsy,to summarize the chronological changes in the clinical features of AILD at initial diagnosis,and to provide a basis for early screening and standardized management. Methods A retrospective analysis was performed for the clinical data of 514 AILD patients who were initially diagnosed at Department of Gastroenterology,Tianjin Medical University General Hospital,from January 2000 to December 2015. According to the time of diagnosis,they were divided into January 2000 to December 2007 group( 86 patients) and January 2008 to December 2015 group( 428 patients). The patients' age at initial diagnosis,disease features,diagnostic methods,proportion of patients with liver cirrhosis and its complications at initial diagnosis,extrahepatic autoimmune diseases,and pathological features on liver biopsy were compared between the two groups. The t- test was used for comparison of continuous data between groups; the chi- square test was used for comparison of categorical data between groups,and the corrected chi- square test or Fisher's exact text was used for the categorical data that cannot be analyzed by the chi- square test. Results Among the 514 patients with AILD,326 had autoimmune hepatitis( AIH),106 had primary biliary cholangitis( PBC),62 had PBC- AIH overlap syndrome,2 had primary sclerosing cholangitis,and 18 had Ig G4- associated pancreaticobiliary diseases. With December 31,2007 as the time dividing point,there was a significant difference in the proportion of patients with liver cirrhosis at initial diagnosis between the two groups( 83. 72% vs 29. 91%,χ2= 84. 996,P < 0. 05). Of all patients,204( 39. 69%) were found to have abnormal liver function during physical examination( no symptoms at initial diagnosis),among whom there were 13 male( 6. 4%) and 191 female( 93. 6%) patients; there was an increased proportion of asymptomatic female patients who visited the hospital due to elevation of aminotransferases found by physical examination after 2007( 22. 4% vs 50. 3%,χ2= 16. 525,P < 0. 01). Of all patients,97( 18. 87%) were transferred due to comorbidity with other diseases from related departments( such as Department of Rheumatology & Immunology),among whom 31( 32. 0%) were male and 66( 68. 0%) were female; there was a significant difference in the proportion of female patients transferred from related departments before and after 2007( 25. 4% vs 14. 0%,χ2= 4. 640,P = 0. 031). There was also a significant difference in the proportion of female patients who had gastrointestinal bleeding at initial diagnosis before and after 2007( 31. 3% vs4. 0%,χ2= 51. 184,P < 0. 01). Among the 171 AILD patients who had other extrahepatic autoimmune diseases,59( 34. 5%) had autoimmune thyroid disease. Among the 244 AILD patients who underwent liver biopsy from 2006 to 2015,there was a significant difference in the proportion of patients with hepatic fibrosis / liver cirrhosis between 2006- 2007,2008- 2009,2010- 2011,2012- 2013,and 2014- 2015( χ2= 15. 487,P = 0. 004); there was a significant difference in the proportion of AILD patients with hepatic fibrosis / liver cirrhosis diagnosed by liver biopsy between 2014- 2015 and 2006- 2007( 25. 5% vs 70. 0%,χ2= 6. 728,P = 0. 009). Conclusion In patients with AILD,there is a significant increase in the proportion of patients who visit the hospital initially due to abnormal liver function found by physical examination,but the age at initial diagnosis tends to decrease. The incidence of liver cirrhosis and complications at initial diagnosis is decreasing year by year. It is suggested that in patients with elevation of aminotransferases found by physical examination,standardized immunological examination and early diagnosis should be taken seriously in order to improve their prognosis.
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