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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 4
Apr.  2022
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The early diagnosis and treatment of atypical autoimmune liver disease should be taken seriously

DOI: 10.3969/j.issn.1001-5256.2022.04.003
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  • Corresponding author: LIU Yanmin, yanmin130@ccmu.edu.cn(ORCID: 0000-0002-8950-1340)
  • Received Date: 2022-01-07
  • Accepted Date: 2022-02-12
  • Published Date: 2022-04-20
  • Autoimmune liver disease is a group of diseases mainly caused by autoimmune abnormalities, including autoimmune hepatitis dominated by hepatocellular injury, primary biliary cholangitis and primary sclerosing cholangitis dominated by bile duct injury, and overlap syndrome with the main features of the above two diseases. Recently, IgG4-related hepatobiliary diseases have also been included in this category, and without timely diagnosis and treatment, it can progress to liver cirrhosis and even liver failure. Different autoimmune liver diseases have their own features, and with the popularization of the knowledge on autoimmune liver diseases, physicians have gradually increased their understanding of such diseases and can achieve the early diagnosis and timely treatment of most typical autoimmune liver diseases. However, some patients may have atypical manifestations or laboratory markers, which may easily delay the diagnosis, and therefore, it is of great importance to identify atypical autoimmune liver disease and give timely diagnosis and treatment as soon as possible.

     

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  • [1]
    HENNES EM, ZENIYA M, CZAJA AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology, 2008, 48(1): 169-176. DOI: 10.1002/hep.22322.
    [2]
    ALVAREZ F, BERG PA, BIANCHI FB, et al. International Autoimmune Hepatitis Group Report: Review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol, 1999, 31(5): 929-938. DOI: 10.1016/s0168-8278(99)80297-9.
    [3]
    YEOMAN AD, WESTBROOK RH, ZEN Y, et al. Prognosis of acute severe autoimmune hepatitis (AS-AIH): The role of corticosteroids in modifying outcome[J]. J Hepatol, 2014, 61(4): 876-882. DOI: 10.1016/j.jhep.2014.05.021.
    [4]
    MACK CL, ADAMS D, ASSIS DN, et al. Diagnosis and management of autoimmune hepatitis in adults and children: 2019 Practice Guidance and Guidelines from the American Association for the Study of Liver Diseases[J]. Hepatology, 2020, 72(2): 671-722. DOI: 10.1002/hep.31065.
    [5]
    YEOMAN AD, WESTBROOK RH, AL-CHALABI T, et al. Diagnostic value and utility of the simplified International Autoimmune Hepatitis Group (IAIHG) criteria in acute and chronic liver disease[J]. Hepatology, 2009, 50(2): 538-545. DOI: 10.1002/hep.23042.
    [6]
    MOENNE-LOCCOZ R, SEVERAC F, BAUMERT TF, et al. Usefulness of corticosteroids as first-line therapy in patients with acute severe autoimmune hepatitis[J]. J Hepatol, 2016, 65(2): 444-446. DOI: 10.1016/j.jhep.2016.03.023.
    [7]
    YASUI S, FUJIWARA K, YONEMITSU Y, et al. Clinicopathological features of severe and fulminant forms of autoimmune hepatitis[J]. J Gastroenterol, 2011, 46(3): 378-390. DOI: 10.1007/s00535-010-0316-3.
    [8]
    FUJIWARA K, FUKUDA Y, YOKOSUKA O. Precise histological evaluation of liver biopsy specimen is indispensable for diagnosis and treatment of acute-onset autoimmune hepatitis[J]. J Gastroenterol, 2008, 43(12): 951-958. DOI: 10.1007/s00535-008-2254-x.
    [9]
    YASUI S, FUJIWARA K, OKITSU K, et al. Importance of computed tomography imaging features for the diagnosis of autoimmune acute liver failure[J]. Hepatol Res, 2012, 42(1): 42-50. DOI: 10.1111/j.1872-034X.2011.00892.x.
    [10]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of autoimmune hepatitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796.

    中华医学会肝病学分会. 自身免疫性肝炎诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 42-49. DOI: 10.3760/cma.j.cn112138-20211112-00796.
    [11]
    RAHIM MN, LIBERAL R, MIQUEL R, et al. Acute severe autoimmune hepatitis: Corticosteroids or liver transplantation?[J]. Liver Transpl, 2019, 25(6): 946-959. DOI: 10.1002/lt.25451.
    [12]
    CASTIELLA A, ZAPATA E, LUCENA MI, et al. Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease[J]. World J Hepatol, 2014, 6(4): 160-168. DOI: 10.4254/wjh.v6.i4.160.
    [13]
    OHMOTO K, YAMAMOTO S. Drug-induced liver injury associated with antinuclear antibodies[J]. Scand J Gastroenterol, 2002, 37(11): 1345-1346. DOI: 10.1080/003655202761020687.
    [14]
    CHEN J, ESLICK GD, WELTMAN M. Systematic review with meta-analysis: Clinical manifestations and management of autoimmune hepatitis in the elderly[J]. Aliment Pharmacol Ther, 2014, 39(2): 117-124. DOI: 10.1111/apt.12563.
    [15]
    SUI M, WU R, HU X, et al. Low prevalence of hepatitis B virus infection in patients with autoimmune diseases in a Chinese patient population[J]. J Viral Hepat, 2014, 21(12): 925-929. DOI: 10.1111/jvh.12302.
    [16]
    LIN XQ, SHENG L, XIAO X, et al. Clinical diagnosis and treatment of chronic hepatitis B complicated with autoimmune hepatitis[J]. Chin J Hepatol, 2020, 28(4): 351-356. DOI: 10.3760/cma.j.cn501113-20190120-00020.

    林小钦, 盛黎, 肖潇, 等. 慢性乙型肝炎合并自身免疫性肝炎的临床诊治分析[J]. 中华肝脏病杂志, 2020, 28(4): 351-356. DOI: 10.3760/cma.j.cn501113-20190120-00020.
    [17]
    HAN X, LI J, ZHOU L, et al. Viral hepatitis with autoimmune hepatitis: A report of 3 cases and literature review[J]. J Clin Hepatol, 2018, 34(11): 2397-2400. DOI: 10.3969/j.issn.1001-5256.2018.11.026.

    韩旭, 李嘉, 周莉, 等. 病毒性肝炎合并自身免疫性肝炎3例报告并文献复习[J]. 临床肝胆病杂志, 2018, 34(11): 2397-2400. DOI: 10.3969/j.issn.1001-5256.2018.11.026.
    [18]
    RIGOPOULOU EI, ZACHOU K, GATSELIS N, et al. Autoimmune hepatitis in patients with chronic HBV and HCV infections: Patterns of clinical characteristics, disease progression and outcome[J]. Ann Hepatol, 2013, 13(1): 127-135. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM24378276
    [19]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of primary biliary cholangitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 35-41. DOI: 10.3760/cma.j.cn112138-20211112-00794.

    中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 35-41. DOI: 10.3760/cma.j.cn112138-20211112-00794.
    [20]
    GRANITO A, MURATORI P, QUARNETI C, et al. Antinuclear antibodies as ancillary markers in primary biliary cirrhosis[J]. Expert Rev Mol Diagn, 2012, 12(1): 65-74. DOI: 10.1586/erm.11.82.
    [21]
    CHEN S, DUAN W, LI M, et al. Prognosis of 732 ursodeoxycholic acid-treated patients with primary biliary cholangitis: A single center follow-up study from China[J]. J Gastroenterol Hepatol, 2019, 34(7): 1236-1241. DOI: 10.1111/jgh.14521.
    [22]
    JULIUSSON G, IMAM M, BJÖRNSSON ES, et al. Long-term outcomes in antimitochondrial antibody negative primary biliary cirrhosis[J]. Scand J Gastroenterol, 2016, 51(6): 745-752. DOI: 10.3109/00365521.2015.1132337.
    [23]
    CHAZOUILLÈRES O, WENDUM D, SERFATY L, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Clinical features and response to therapy[J]. Hepatology, 1998, 28(2): 296-301. DOI: 10.1002/hep.510280203.
    [24]
    BOBERG KM, CHAPMAN RW, HIRSCHFIELD GM, et al. Overlap syndromes: The International Autoimmune Hepatitis Group (IAIHG) position statement on a controversial issue[J]. J Hepatol, 2011, 54(2): 374-385. DOI: 10.1016/j.jhep.2010.09.002.
    [25]
    KUIPER EM, ZONDERVAN PE, van BUUREN HR. Paris criteria are effective in diagnosis of primary biliary cirrhosis and autoimmune hepatitis overlap syndrome[J]. Clin Gastroenterol Hepatol, 2010, 8(6): 530-534. DOI: 10.1016/j.cgh.2010.03.004.
    [26]
    FAN X, WANG T, SHEN Y, et al. Underestimated male prevalence of primary biliary cholangitis in China: Results of a 16-yr cohort study involving 769 patients[J]. Sci Rep, 2017, 7(1): 6560. DOI: 10.1038/s41598-017-06807-7.
    [27]
    LIU YM, YAN HP, LIAO HY, et al. Clinical and laboratory characteristics of male patients with primary biliary cirrhosis[J]. J Clin Hepatol, 2010, 26(1): 54-56. http://lcgdbzz.org/article/id/LCGD201001023

    刘燕敏, 闫惠平, 廖慧钰, 等. 男性原发性胆汁性肝硬化患者临床与实验室特点分析[J]. 临床肝胆病杂志, 2010, 26(1): 54-56. http://lcgdbzz.org/article/id/LCGD201001023
    [28]
    MAYO MJ. Natural history of primary biliary cirrhosis[J]. Clin Liver Dis, 2008, 12(2): 277-288; viii. DOI: 10.1016/j.cld.2008.02.012.
    [29]
    MITCHISON HC, BASSENDINE MF, HENDRICK A, et al. Positive antimitochondrial antibody but normal alkaline phosphatase: Is this primary biliary cirrhosis?[J]. Hepatology, 1986, 6(6): 1279-1284. DOI: 10.1002/hep.1840060609.
    [30]
    SUN C, XIAO X, YAN L, et al. Histologically proven AMA positive primary biliary cholangitis but normal serum alkaline phosphatase: Is alkaline phosphatase truly a surrogate marker?[J]. J Autoimmun, 2019, 99: 33-38. DOI: 10.1016/j.jaut.2019.01.005.
    [31]
    TERZIROLI BERETTA-PICCOLI B, STIRNIMANN G, MERTENS J, et al. Primary biliary cholangitis with normal alkaline phosphatase: A neglected clinical entity challenging current guidelines[J]. J Autoimmun, 2021, 116: 102578. DOI: 10.1016/j.jaut.2020.102578.
    [32]
    LIU YM, LIAO HY, YAN HP, et al. Clinical analysis of short-term rise of bilirubin in patients with primary biliary cirrhosis[J]. Chin J Hepatol, 2012, 20(8): 632-633. DOI: 10.3760/cma.j.issn.1007-3418.2012.08.019.

    刘燕敏, 廖慧钰, 闫惠平, 等. 原发性胆汁性肝硬化患者胆红素短期内上升临床分析[J]. 中华肝脏病杂志, 2012, 20(8): 632-633. DOI: 10.3760/cma.j.issn.1007-3418.2012.08.019.
    [33]
    European Association for the Study of the Liver. EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis[J]. J Hepatol, 2017, 67(1): 145-172. DOI: 10.1016/j.jhep.2017.03.022.
    [34]
    FRICKER ZP, LICHTENSTEIN DR. Primary sclerosing cholangitis: A concise review of diagnosis and management[J]. Dig Dis Sci, 2019, 64(3): 632-642. DOI: 10.1007/s10620-019-05484-y.
    [35]
    Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management of primary sclerosing cholangitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 50-61. DOI: 10.3760/cma.j.cn112138-20211109-00786.

    中华医学会肝病学分会. 原发性硬化性胆管炎诊断及治疗指南(2021)[J]. 临床肝胆病杂志, 2022, 38(1): 50-61. DOI: 10.3760/cma.j.cn112138-20211109-00786.
    [36]
    FLOREANI A, RIZZOTTO ER, FERRARA F, et al. Clinical course and outcome of autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome[J]. Am J Gastroenterol, 2005, 100(7): 1516-1522. DOI: 10.1111/j.1572-0241.2005.41841.x.
    [37]
    van BUUREN HR, van HOOGSTRATEN H, TERKIVATAN T, et al. High prevalence of autoimmune hepatitis among patients with primary sclerosing cholangitis[J]. J Hepatol, 2000, 33(4): 543-548. DOI: 10.1034/j.1600-0641.2000.033004543.x.
    [38]
    KAYA M, ANGULO P, LINDOR KD. Overlap of autoimmune hepatitis and primary sclerosing cholangitis: An evaluation of a modified scoring system[J]. J Hepatol, 2000, 33(4): 537-542. DOI: 10.1034/j.1600-0641.2000.033004537.x.
    [39]
    AL-CHALABI T, PORTMANN BC, BERNAL W, et al. Autoimmune hepatitis overlap syndromes: an evaluation of treatment response, long-term outcome and survival[J]. Aliment Pharmacol Ther, 2008, 28(2): 209-220. DOI: 10.1111/j.1365-2036.2008.03722.x.
    [40]
    WANG L, HAN Y. An excerpt of British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis (2019)[J]. J Clin Hepatol, 2019, 35(9): 1937-1941. DOI: 10.3969/j.issn.1001-5256.2019.09.010.

    王璐, 韩英. 《2019年英国胃肠病学会和英国原发性硬化性胆管炎协作组指南: 原发性硬化性胆管炎的诊断和治疗》摘译[J]. 临床肝胆病杂志, 2019, 35(9): 1937-1941. DOI: 10.3969/j.issn.1001-5256.2019.09.010.
    [41]
    DENEAU MR, MACK C, MOGUL D, et al. Oral vancomycin, ursodeoxycholic acid, or no therapy for pediatric primary sclerosing cholangitis: A matched analysis[J]. Hepatology, 2021, 73(3): 1061-1073. DOI: 10.1002/hep.31560.
    [42]
    TANAKA A, MORI M, KUBOTA K, et al. Epidemiological features of immunoglobulin G4-related sclerosing cholangitis in Japan[J]. J Hepatobiliary Pancreat Sci, 2020, 27(9): 598-603. DOI: 10.1002/jhbp.793.
    [43]
    OHARA H, NAKAZAWA T, KAWA S, et al. Establishment of a serum IgG4 cut-off value for the differential diagnosis of IgG4-related sclerosing cholangitis: A Japanese cohort[J]. J Gastroenterol Hepatol, 2013, 28(7): 1247-1251. DOI: 10.1111/jgh.12248.
    [44]
    ZEN Y, HARADA K, SASAKI M, et al. IgG4-related sclerosing cholangitis with and without hepatic inflammatory pseudotumor, and sclerosing pancreatitis-associated sclerosing cholangitis: Do they belong to a spectrum of sclerosing pancreatitis?[J]. Am J Surg Pathol, 2004, 28(9): 1193-1203. DOI: 10.1097/01.pas.0000136449.37936.6c.
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