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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 12
Dec.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(12): 2744-2749

Liver histopathology and clinical features of autoimmune hepatitis with different antibody statuses

DOI: 10.3969/j.issn.1001-5256.2022.12.012
  • 1.

    Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

  • 2.

    Department of Hepatology Division 2, Peking University Ditan Teaching Hospital, Beijing 100015, China

Research funding:

Beijing Hospitals Authority Clinical medicine Development of special funding support (XMLX202127);

National Science and Technology Major Project of China (2017ZX10201201-001-006);

National Science and Technology Major Project of China (2017ZX10201201-002-006);

National Science and Technology Major Project of China (2018ZX10715-005-003-005);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXZ0302);

The Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (XXT28);

Special Public Health Project for Health Development in Capital (2022-1-2172);

Project supported by Beijing science and technology commission (Z211100002921059);

High-level Public Health Technical Personnel Training Program of Beijing Municipal Health Commission (2022-3-050)

More Information
  • Corresponding author: LI Minghui, Wuhm2000@sina.com (ORCID: 0000-0003-3233-5473); XIE Yao, xieyao00120184@sina.com (ORCID: 0000-0003-4108-7037)
  • Received Date: 2022-06-01
  • Accepted Date: 2022-07-13
  • Published Date: 2022-12-20
    Abstract
  •   Objective  To compare clinical and pathological features between autoimmune hepatitis (AIH) patients with positive and negative autoantibodies, and to summarize the experience in diagnosis.  Methods  A retrospective analysis was performed for the patients who attended Beijing Ditan Hospital from January 2010 to August 2021 and were diagnosed with AIH by liver histopathology, and according to the presence or absence of autoantibodies, they were divided into positive autoantibody group and negative autoantibody group. The two groups were compared in terms of biochemical parameters, immunological features, histopathological features, disease stage, and clinical symptoms and signs. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data.  Results  A total of 110 patients were enrolled, among whom 78 (71%) had positive autoantibodies and 32 (29%) had negative autoantibodies. Anti-nuclear antibody (ANA), anti-mitochondrial antibody (AMA), and anti-smooth muscle antibody (ASMA) were the main autoantibodies detected, and of all 110 patients, 74 (67.27%) had positive ANA, 1 (0.91%) had positive AMA, 5 (4.55%) had positive ASMA, and 14 (12.73%) had positive anti-Ro-52 antibody. As for clinical and immunological features, compared with the positive autoantibody group, the negative autoantibody group had significantly lower incidence rates of jaundice of the skin and sclera (21.90% vs 50.00%, χ2=7.377, P=0.007) and poor appetite (18.80% vs 41.00%, χ2=4.979, P=0.026) and significantly lower median levels of direct bilirubin [7.30(4.05~12.10) μmol/L vs 16.80(6.48~69.75) μmol/L, Z=-2.304, P=0.021], IgG [16.40(13.15~18.05) g/L vs 20.30(16.00~27.15) g/L, Z=-2.715, P=0.007], and GLo [30.60(26.00~34.90) g/L vs 37.30(30.50~42.50) g/L, Z=-3.356, P=0.001]. In terms of liver histopathology, compared with the negative autoantibody group, the positive autoantibody group had a significantly higher proportion of patients with lymphocyte infiltration (91.03% vs 68.75%, χ2=6.997, P=0.008) and plasma cell infiltration (82.05% vs 50.00%, χ2=11.572, P=0.001); compared with the ANA-negative patients, the ANA-positive patients had significantly higher inflammation grade (G1-G4) (9.46%/16.22%/44.59%/29.73% vs 5.56%/27.78%/63.89%/2.78%, Z=-2.179, P=0.029) and fibrosis degree (S1-S4) (37.84%/25.68%/32.43%/4.05% vs 13.89%/41.67%/30.56%/13.89%, Z=-0.082, P=0.037).  Conclusion  Compared with AIH patients with positive autoantibodies, AIH patients with negative autoantibodies are mostly in the early stage of the disease and tend to have a low level of IgG, with a relatively high rate of missed diagnosis in clinical practice. Early and active liver biopsy is of particular importance.

     

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