Evaluation Of The Differences Between Two Scoring Systems For Diagnosis Of Autoimmune Hepatitis

Objective: To evaluate the differences of the two scoring systems of autoimmunehepatitis (AIH) in Chronic hepatitisMethods: Fifty AIH patients and fourteen other autoimmune diseases (control group)patients admitted to the Liver Research Center of the First Affiliated Hospitalof Fujian Medical University between1stDecember2008and31stDecember2013were enrolled in this study. All AIH patients underwent liver biopsy and Scored allthe patients of AIH ans other autoimmune diseases with the revised original criteriaand the simplified criteria, then analyzed the sensitivity of two scoring systems indiagnosis. Compared the differences of diagnosis between the AIH patients and otherautoimmune diseases patients, and the difference of some projects. SPSS19.0software was used for statistical analysis. P <0.05indicated differences with astatistical significance.Results:1. Fifty-nine AIH and fourteen other autoimmune diseases patients enrolledinto the study. And AIH patients was including39patients of pure AIH,4patients ofDAIH,16patients of AIH/PBC overlap syndrome. There were54female patients(91.5%) in AIH patients,and the median age was53.0(43.0-59.0) years. Theproportion of female patients and the median age between AIH and the control groupshowed no significant difference (P>0.05).2. Revised original criteria (≥10)diagnosed56patients with definite and probable AIH in the patients of AIH,including39patients of pure AIH,4patients of DAIH, and13patients of AIH/PBCoverlap syndrome, and11patients in other autoimmune diseases. Simplified criteria(≥6) diagnosed36patients of AIH with25pure AIH,2DAIH and9AIH/PBCoverlap syndrome as definite and probable AIH, and none patients of other autoimmune diseases.3. The Identification capability of AIH(including the "definiteAIH" and "probable AIH"), the revised original criteria was much greater than thesimplified criteria (94.9%vs44.1%). On the level of "definite AIH" level, therevised original criteria was much greater than the simplified criteria (44.1%vs32.2%). The sensitivity of the revised original criteria were44.1%for definite AIH(>15) and94.9%for probable AIH (≥10). In comparison, the sensitivity of thesimplified criteria were32.2%and44.1%for definite AIH (≥7) and probable AIH (≥6), respectively.4. In the patient with normal serum GLO, the compliance rate of therevised original criteria to diagnosis AIH (≥10) was89.7%before treatment and89.7%after responding to treatment, While the compliance rate of simplify criteria forthe diagnosis of AIH (≥6) was31.0%. And in the patients of negative ANA or SMAantibody, the compliance of the revised original criteria for the diagnosis of AIH (≥10)was94.1%whether the treatment, the simplify criteria for the diagnosis of AIH (≥6)with a compliance rate of29.4%.5. The revised original criteria diagnosis11patientsof other autoimmune diseases as AIH (false positive group). The ALP: AST andALP: ALT ratio in the false-positive group was higher than the true-negative group (P<0.05), while the serum IgG levels, the proportion of female patients, positivity forANA or SMA antibody in the false-positive group were less than that in thetrue-negative group, but the difference was no significant (P>0.05).6. Thesimplified criteria diagnosed14AIH patients as "non-diagnostic AIH"(thefalse-negative group). The serum level of GLO, IgG in the true-positive group weresignificantly higher than that in the false-negative group with the GLO serum level,38.3(5.75-44.6) g/L vs30.4(27.2-38.5) g/L (P=0.002), and the serum level of IgG23.8(18.8-28.8) g/L vs13.8(13.0-14.9) g/L (P=0.000).Conclusions: The compliance of the revised original criteria for the diagnosis of AIHmaybe higher than the simplified criterial. Application scoring system diagnosticsAIH in the patients of lower IgG levels, less frequent positivity for ANA or SMAantibody, revised original criteria may be more suitable than the simplified criteria.While in autoantibody≥1:40level of titers, the simplified criteria for the diagnosis ofAIH may be better than the revised original criteria. In AIH/PBC overlap syndrome, the sensitivity of the application of the original revised criteria and the simplifiedcriteria to diagnosis AIH were all decreased. In the patients with normal serum levelof GLO, or the negative for ANA and SMA antibody, the compliance rates alldecreased for the revised original criteria and the simplified criteria for diagnosingAIH, and the revised original criteria may be more suitable for diagnosis in thispopulation. While the simplify criteria maybe more applicable to discriminate AIH inthe patients of other autoimmune diseases with higher serum IgG levels, morefrequent positivity for ANA or SMA antibodies and lower ALP: AST ratio level.