General Characteristics of Our Patients Diagnosed with Autoimmune Hepatitis: Single Center Experience

Yıl 2024, Cilt: 16 Sayı: 2, 13 - 23, 31.08.2024

Ramazan Yolacan , Cihat Yıldırım Muhsin Kaya

https://doi.org/10.56484/iamr.1454580

Öz

Objective:Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease characterized by elevated liver enzymes and serum immunoglobulin levels, often accompanied by high titers of autoantibodies, typical histopathological findings, and a diagnosis established upon the exclusion of other liver diseases. The etiology of AIH is not fully understood. Our aim was to investigate the general characteristics of our AIH patients, the treatments administered, and the responses to these treatments, and to compare these with the data available in the literature.
Materials and Methods:Between 2010-2020, data from 62 patients diagnosed with AIH at our clinic were retrospectively reviewed. The study investigated the general characteristics at the time of diagnosis, laboratory values, autoantibody levels, the presence of additional autoimmune diseases, liver histology, treatment status and responses, as well as average follow-up and survival times.
Results:Of the patients, 57 (91.9%) were female, with a female to male ratio of 11:1, and the average age of all patients was 34.76±14.9 years. The average follow-up duration was 34.7±23.4 months, the average survival time was 105 months, and the 5-year survival rate was determined to be 92%. At the time of diagnosis, a more than tenfold increase in aminotransferase levels and acute hepatitis were statistically significantly higher in females (p<0.05). While there was a statistically significant relationship between the average time to remission and aminotransferase levels (p<0.05), no significant relationship was found between the development of relapse (p>0.05). A statistically significant conversion was observed between patients with definite and probable diagnoses before and after treatment (p<0.05).
Conclusion:AIH should always be considered in patients with acute and chronic liver disease, hypergammaglobulinemia, and especially those with other autoimmune diseases, as AIH presents with various clinical, laboratory, and histological features. It is important to remember that AIH responds well to treatment and patients can be maintained in remission for extended periods with appropriate therapy.

Anahtar Kelimeler

ANA, Autoimmune hepatitis, Cirrhosis

Etik Beyan

This study was approved by the Non-Interventional Clinical Research Ethics Committee of Dicle University Faculty of Medicine with decision number 84 dated 05.03.2020.

Destekleyen Kurum

Dicle University Faculty of Medicine

Kaynakça

• Ngu JH, Bechly K, Chapman BA, et al. Population-based epidemiology study of autoimmune hepatitis: a disease of older women? J Gastroenterol Hepatol 2010;25:1681-6.
• Delgado JS, Vodonos A, Malnick S, et al. Autoimmune hepatitis in southern Israel: a 15-year multicenter study. J Dig Dis 2013;14:611-8.
• EASL Clinical Practice Guidelines: Autoimmune hepatitits, journal of hepatology 2015 volume 63, 971-1004.
• Lohse AW, Vergani GM. Autoimmune hepatitis, journal of hepatology 2011 volume 55, 171-182.
• Gatselis NK, Zachou K, Koukoulis GK, Dalekos GN. Autoimmune hepatitis, one disease with many faces: Etiopathogenetic, clinico-laboratory and histological characteristics, World J. Gastroenterology 2015 January 7; 21 (1): 60-83.
• Manns PM, Lohse AW, Vergani D. Autoimmune hepatitis–Update 2015, journal of Hepatology 2015 volume 62, 100–111.
• Rizvi S, Gawrieh S. Autoimmune Hepatitis in the Elderly: Diagnosis and Pharmacologic Management, Springer International Publishing AG, 4 July 2018, 589-602.
• Gleeson D, Heneghan MA. British Society of Gastroenterology. British Society of Gastroenterology (BSG) guidelines for management of autoimmune hepatitis. Gut 2011; 60, 1611-1629.
• Manns MP, Vergani D. Autoimmune hepatitis. Semin Liver Dis. 2009; 29 (3): 239-240.
• Gupta R, Agarwal SR, Jain M, et al. Autoimmune hepatitis in the Indian subcontinent: 7 years experience. J. Gastroenterology Hepatology 2001; 16 (10): 1144-1148.
• Peng M, Li Y, Zhang M, et al. Clinical features in different age groups of patients with autoimmune hepatitis. Exp. Ther. Med. 2014; 7 (1): 145-148.
• Van Gerven NM, Verwer BJ, Witte BI, et al. Epidemiology and clinical characteristics of autoimmune hepatitis in the Netherlands. Scand J. Gastroenterology 2014 Oct; 49 (10): 1245-1254.
• Czaja AJ, Manns MP. The validity and importance of subtypes in autoimmune hepatitis: a point of view. Am. J. Gastroenterology 1995; 90 (8): 1206-1211.
• Granito A, Muratori L, Pappas G, et al. Clinical features of type 1 autoimmune hepatitis in elderly Italian patients. Aliment Pharmacol Ther 2005 Sep; 21: 1273-1277.
• Czaja AJ. The overlap syndromes of autoimmune hepatitis. Dig. Dis. Sci. 2013; 58 (2): 326- 343.
• Nayagam JS, Miquel R, Joshi D. Overlap Syndrome with Autoimmune Hepatitis and Primary Sclerosing Cholangitis EMJ Hepatology 2019; 7 (1): 95-104.
• Liberal R, Grant CR, Mieli-Vergani G, et al. Autoimmune hepatitis: A comprehensive review. Journal of Autoimmunity. 2013; 41: 126–139.
• Chazouilleres O. Diagnosis of primary sclerosing cholangitis autoimmune hepatitis overlap syndrome: to score or not to score? J. Hepatology 2000; 33 (4): 661-663.
• Czaja AJ. Performance parameters of the conventional serological markers for autoimmune hepatitis. Dig. Dis. Sci. 2011; 56 (2): 545-554.
• Mieli-Vergani G, Heller S, Jara P, et al. Autoimmune hepatitis. J. Pediatr. Gastroenterology Nutr. 2009; 49 (2): 158-164.
• Abe M, Mashiba T, Zeniya M, et al. Autoimmune Hepatitis Study Group-Subgroup of the Intractable Hepato-Biliary Disease Study Group in Japan. Present status of autoimmune hepatitis in Japan: a nationwide survey. J. Gastroenterology 2011 Sep; 46 (9): 1136-1141.
• Kil JS, Lee JH, Han AR, et al. Long-term treatment outcomes for autoimmune hepatitis in Korea. J. Korean Med. Sci. 2010; 25 (1): 54-60.
• Takahashi A, Arinaga-Hino T, Ohira H, et al. Autoimmune hepatitis in Japan: trends in a nationwide survey. J. Gastroenterology 2017; 52 (5): 631-640.
• Muratori P, Fabbri A, Lalanne C, et al. Autoimmune liver disease and concomitant extrahepatic autoimmune disease. Eur. J. Gastroenterology Hepatology 2015; 27 (10): 1175-1179.
• Feld JJ, Dinh H, Arenovich T, et al. Autoimmune hepatitis: effect of symptoms and cirrhosis on natural history and outcome. Hepatology 2005; 42 (1): 53-62.
• Czaja AJ. Global Disparities and Their Implications in the Occurrence and Outcome of Autoimmune Hepatitis, Dig. Dis. Sci. 2017 Sep; 62 (9): 2277-2292.
• Van Gerven NM, De Boer YS, Mulder CJ, et al. Autoimmune hepatitis. World J. Gastroenterology 2016 May 21; 22 (19): 4651-4561.
• Kil JS, Lee JH, Han AR, et al. Long-term treatment outcomes for autoimmune hepatitis in Korea. J. Korean Med. Sci. 2010; 25 (1): 54-60.
• Czaja AJ, Carpenter HA. Histological features associated with relapse after corticosteroid withdrawal in type 1 autoimmune hepatitis. Liver international: official 113 journal of the International Association for the Study of the Liver. 2003; 23 (2): 116-123.
• Yoshizawa K, Joshita S, Matsumoto A, et al. Incidence and prevalence of autoimmune hepatitis in the Ueda area, Japan. Hepatol Dec. 2016;46(9):878-83.
• Kil JS, Lee JH, Han AR, et al. Long-term treatment outcomes for autoimmune hepatitis in Korea. J. Korean Med. Sci. 2010; 25 (1): 54-60.
• European Association for the Study of the (EASL) Clinical Practice Guidelines: Autoimmune hepatitis. J. Hepatology 2015; 63 (4): 971-1004.