Clinical Analysis Of Autoimmune Hepatitis Combined With Autoimmune Diseases Of 149 Cases

Objective To analyze the clinical data of 149 patients with autoimmune hepatitis in the second affiliated hospital of Dalian Medical University,to make clear the differences of the clinical features,complications and progression rate of liver fibrosis/cirrhosis of patients with autoimmune hepatitis(AIH)with primary biliary cholangitis(PBC)or extrahepatic autoimmune disease and patients with AIH alone,to provide a reference for improving the diagnosis and treatment of patients with AIH.Method A total of 149 AIH cases admitted in the second affiliated hospital of Dalian Medical University from august 1999 to august 2019 were collected and divided into AIH group without complications(68 cases),AIH combined with PBC group(AIH-PBC group,41 cases),and AIH combined with extrahepatic autoimmune disease group(AIH-extrahepatic group,40 cases)according to the complications.To contrast and analysis the information on the initial diagnosis age,sex composition,clinical symptoms,liver biochemistry,immunoglobulin,autoantibodies,pathological histology,complications,and progression of liver fibrosis/cirrhosis in these inpatients.ResuIts ①In this study,the mean age of initial diagnosis in AIH group,AIH-PBCgroup and AIHextrahepatic group were(56.85±12.65)years old,(52.00±10.78)years old,(52.00±10.04)years old,and the age of AIH-PBC group and AIH-extrahepatic group were lower than that of AIH group(p<0.05),the difference was statistically significant(p<0.05).In this study,there were 24 males(16.11%)and 125 females(83.89%),and the incidence ratio of male and female was 1:5.21.The ratio of male and female in AIH group,AIH-PBC group and AIH-extrahepatic group were 1:5.18,1:4.86,1:5.67,and the sex composition difference of the three groups was not statistically significant(p>0.05).②The common clinical symptoms in the three groups were itching,jaundice,fatigue,loss of appetite and abdominal discomfort,there were more patients with itchy symptoms in the AIHPBC group than in the AIH group and the AIH-extrahepatic group,the difference was statistically significant(p<0.05),and there was no significant difference in jaundice,fatigue,loss of appetite and abdominal discomfort in the three groups(p>0.05).③AIHPBC group had lower ALT than AIH group and AIH-extrahepatic group,but higher ALP and GGT than AIH group and AIH-extrahepatic group,the difference was statistically significant(p<0.05).AST,DBIL and IgG in AIH-extrahepatic group were higher than AIH group and AIH-PBC group,the difference was statistically significant(p<0.05).④AIH-PBC group had 23 positive cases of AMA(56.10%)and 28 positive cases of AMA-M2(68.30%).There were no positive cases in the other two groups.The positive rate of AMA and AMA-M2 in AIH-PBC group was higher than that of AIH group and AIH-extrahepatic group,the difference was statistically significant(p<0.05).There was no significant differences about the positive rate of ANA,ASMA,SLA and LKM-1 in three groups(p>0.05).⑤A total of 32 cases(21.48%)of the 149 patients underwent liver biopsy,including 12 cases in AIH group,12 cases in AIH-PBC group and 8 cases in AIH-extrahepatic group.The histopathological findings of the three groups were mostly characterized by interfacial hepatitis and lymphocyte infiltration.The number of positive cases of cholangiopathy and cholestasis in the AIH-PBC group were 11 cases(91.67%)and 7 cases(58.33%),respectively.The positive rate of cholangiopathy and cholestasis were higher than that in the AIH group,the difference was statistically significant(p<0.05).⑥The complications of the three groups included esophageal and gastric varices/ruptured bleeding,ascites,hepatic encephalopathy,and liver cancer.There was no significant difference among the groups(p>0.05).⑦The difference about the incidence of liver fibrosis/cirrhosis in the three groups was not statistically significant(p>0.05),but the progression rate of 2-5 years about liver fibrosis/cirrhosis in the AIH-PBC group was higher in than that in the AIH group and the AIH-extrahepatic,the difference was statistically significant(p<0.05).Conclusion ①Middle-aged and elderly women are more susceptible to AIH,the combination of PBC or extrahepatic autoimmune disease could lead to earlier first diagnosis of AIH patients.②AIH patients with PBC had a lighter inflammatory response in the liver than patients with AIH alone,but more severe bile duct lesions.③Patients in the AIH-PBC group were more prone to itch,more severe cholestasis and more severe bile duct damage than those in the AIH group and the extrahepatic group,and the liver fibrosis/cirrhosis of 2-5 years progressed faster.④ The AMA and AMA-M2 of can be used as identification indicators for AIH combined with PBC.⑤Liver function damage is often found in extrahepatic autoimmune diseases,IgG is significant to suggest AIH combined with extrahepatic autoimmune diseases.