Analysis Of Clinical Application And Factors Of Autoimmune Hepatitis Scoring Diagnostic Systems

Objective: To study the consistency between clinical diagnosis and scoring diagnosis of AIH,to analyze the clinical application of AIH scoring diagnostic systems,to evaluate whether there is overdiagnosis or underdiagnosis,and to discuss the factors affecting the consistency of scoring diagnosis and clinical diagnosis.Materials and methods: A total of 597 patients with AIH who were admitted to the Second Affiliated Hospital of Chongqing Medical University from January 2010 to December 2018 were retrospectively collected.The revised scoring diagnostic system and simplified diagnostic scoring criteria were used for scoring diagnosis,respectively,and compared with clinical diagnosis.Results: 1.In 50 cases,the clinical diagnosis was consistent with that made by the revised scoring diagnostic system,and in 9 cases,the diagnosis was consistent with that made by the simplified diagnostic scoring criteria.2.The absence of ALP,ANA/ASMA/AMA had no significant effect on the consistency between the two scoring diagnosis and clinical diagnosis(P>0.05).The absence of HBV markers had no significant effect on the consistency between the simplified diagnostic scoring criteria diagnosis and the clinical diagnosis(P>0.05),but had an effect on the consistency between the revised diagnostic system disgnosis and the clinical diagnosis(P<0.05).However,no Ig G and pathological examination had significant effects on the consistency betweenthe two scoring diagnosis and clinical diagnosis(P<0.05).3.There was no significant difference in the diagnosis before and after treatment with glucocorticoid or immunosuppressant in patients diagnosed with "definite AIH" and "probable AIH".4.Assuming that the score of AMA-M2 was the same as that of AMA,it was found that after the addition of AMA-M2,AIH could be excluded partly in the group of patients with and only positive AMA-M2.Moreover,after the addition of AMA-M2,there was no significant difference in the sensitivity of exclusion diagnosis of AIH between the "with and only positive AMA-M2" group and the "with and only positive AMA" group,and the "both positive AMA and AM-M2" group(P>0.05).5.Patients clinically diagnosed with AIH and AIH cirrhosis had statistical differences in the scoring diagnosis of "AIH","probable AIH" and "excluded AIH" in the revised diagnostic system and the simplified diagnostic scoring criteria(P<0.05).6.Patients clinically diagnosed with AIH and AIH/PBC overlap syndrome had statistical differences in the scoring of "AIH","probable AIH" and "excluded AIH" in the simplified diagnostic scoring criteria(P<0.05),but no statistical differences in the revised diagnostic system(P>0.05).Conclusions: 1.The consistency between the clinical diagnosis and the scoring diagnosis of AIH is low,indicating that the clinical application of the AIH scoring diagnostic systems is poor and there may be overdiagnosis or underdiagnosis.2.Ig-G,liver histopathological examination and HBV markers were not detected,which had an impact on the consistency of scoring diagnosis and clinical diagnosis.3.For patients diagnosed as "probable AIH",the diagnosis cannot be made solely on the response to glucocorticoids or immunosuppressive agents.4.AMA-M2 has significance in the exclusion of diagnosis of AIH.5.Cirrhosis has influence on AIH revised scoring diagnostic system and simplified diagnostic scoring criteria.6.The complication of PBC has an effect on AIH simplified diagnostic scoring criteria,but has no significant effect on revised scoring diagnostic system.