Retrospective Analysis Of76Inpatients With Autoimmune Liver Disease And Meta-analysis On Ursodesoxycholic Acid For Primary Biliary Cirrhosis

Objective:①To analyze and compare the clinical and biochemical characteristics, autoantibodies and histopathological lesions between autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) and to improve the diagnosis about them;②omprehensive evaluation the long-term efficiency and safety of ursodeoxycholic acid(UDCA) treatment for PBC.Methods:①aking retrospective analysis of Clinical data of76cases of autoimmune liver disease (AIH/PBC47/29) admitted to Xiangya Hospital Central-south University from October2003to November2010. Figuring out the proportion of the of tthe clinical manifestations、 autoantibodies and histologic features According to the statistical data type;②hrough search Chinese(CNKI, WANGFANG, VIP) and English (Pubmed, EMBase, Coehrane Library) database, according to the inclusion and exclusion standard collect data and using Meta software to analysis the data.Results:①he AIH and PBC most frequently affected middle-aged women88.2%(67/76). The mean time interval between the first visit to physicians to the time of correct diagnosis was over1.9years, yet the patients with PBC had longer illness duration.21.1%(16/76) of the patients were presented with autoimmune disorders, of which Sjogren’s syndrome was more frequengly found(11.8%). The main clinical manifestations were malaise, anOrexia, flatulency, jaundice and pruritus, which were lack of specificity. ALT and AST levels were markedly elevated in patients with AIH, while the most elevated biochemical indexes wree ALP,GGT with the cases of PBC. Elevated serum gamma globulin and IgG were found in patient with AIH and PBC,IgM in PBC significantly higher. There were many circulating of autoantibodies, More than90%of the patients were presence of circulating of auto-antilxlies antibodies(ANA),93.1%of the cases with PBC were positive for anti-mitochondrial antibody-M2(AMA-M2). The patients both AIH and PBC eventually can progress to cirrhosis decompensated period, which was common in patients with PBC;②Eight trials involving1084patients with PBC were included, there were544participants in treatment group and540participants in control group. Meta-analysis showed: primary outcomes were not significant different in the incidence of death,liver transplantation, death and/or liver transplantation and liver decompensation; symptoms were not significant different in the fatigue and pruritus; liver biochemical indicators were significant different in the serum alkaline phosphatase, γ-glutamyltransferase, alanine transaminase,Aspartate transaminase and IgM; adverse events were not different significant.Conclusion:①AIH and PBC mainly affected middle-aged women, lack of specific clinical features, the diagnostic needs comprehensive data about clinical manifestations, biochemical characteristics, autoantibodies and histolo-gical features, the AIH diagnostic scoring system can use for diagnosis the difficult cases;②Long-term and medium dosage treating PBC with UDCA could improve liver biochemistry indicators, but it could not improve the symptom, decrease the incidence of death, liver transplantion and liver decompensation. UDCA may delay the liver histologic progression in the early stage patients with PBC, with a low incidence of adverse events. Thus, patients with early and long-term treatment vas very important.