Analysis Of The Current Status Of 182 Cases Of Autoimmune Hepatitis In Our Hospital In The Past Ten Years

Object:To analyze the status of autoimmune hepatitis(AIH)from the clinical manifestations,blood biochemistry,autoantibodies,liver pathology testing,treatment and other aspects of clinical data.Methods:Retrospectively analyze the clinical data,clinical manifestations,serology,immunology,imageological,histological examination results,treatment and rehospitalization of 182 patients who were clearly diafnosed with AIH in the Department of Hepatology,First Hospital of Jilin University from February 2009 to February 2019.Result:Of all the 182 patients,179 were AIH-I,3 were AIH-II,156 were simple AIH,and 26 were AIH-PBC overlapping syndrome.Male to female ratio was 1:12,the onset age was 12 to 83 years old,and the median age was 55 years.The main clinical manifestations were anorexia,greasy,nausea and other gastrointestinal symptoms(60.4%),fatigue(54.9%),jaundice(51.1%),9.9% of patients without clinical symptoms,only due to physical examination found abnormal liver function,Another3.1% of patients presented with extrahepatic symptoms(xerostomia,exrophtalmia,arthralgia).20.3% of patients also have other autoimmune diseases,of which Sjogren’s syndrome is the most common.The results of liver function test at the time of admission was the most obvious with AST and ALT elevation,84.6%A/G ratio is lower than normal,44.5% immunoglobulin was above the upper limit of normal,IgG elevation was the most common.97.8% of patients were ANA positive and 8.8% were SMA positive.There were no significant differences in AST,ALT,ALB,GLB,A/G,TBil,DBil,IgG,and IGA levels between the AIH group and AIH-PBC overlapsyndrome group.The ALP,GGT,and IgM values of the AIH-PBC overlap syndrome group were significantly higher than those of the AIH group.The positive rate of AMA-M2,anti-GP210,and anti-SP100 in the AIH-PBC overlap syndrome group was also significantly higher than that in the AIH group.29.1% of the patients had cirrhosis at the initial admission,and there was no significant differences between the AIH group and AIH-PBC overlap syndrome group.111 patiens underwent liver biopsy pathology,108 patients showed lymphocyte and plasma cell infiltration in the portal area,and 106 patients had different degrees of "interface inflammation"(mild degree25 cases,moderate degree 48 cases,severe degree 33 cases),87 patients there were different degrees of fibrous tissue hyperplasia in the portal area(S1 35 cases,S2 29 cases S3 18 cases S4 5 cases),22 cases showed typical hepatic rosette formation,and1 case showed emperipolesis.98 cases showed hepatocyte degeneration and necrosis in different degrees,and bridging necrosis was found in 66 cases.The positive rate of bile duct injury in AIH-PBC overlap syndrome group was significantly higher than in AIH group.96 patients received immunosuppressive therapy.The remaining 86 patients received symptomatic supportive therapy.Including 10 patients who did not need immunosuppressive therapy because of low inflammation,and 35 cases who did not receive immunosuppressive therapy because of severe complications or immunosuppressive contraindications in decompensated cirrhosis.The AST,ALT values and liver biopsy in the immunosuppressive therapy group showed a higher rate of bridging necrosis than non-immunosuppression therapy group.In this study,47(26.3%)were re-hospitalized for various reasons.Among them,the proportion of re-hospitalized patients in non-immunosuppressive therapy group was significantly higher than that in immunosuppressive therapy group due to decompensated cirrhosis complications such as gastrointestinal hemorrhage and liver failure.The patients in the immunosuppressive therapy group had a higher proportion(28.6%)of re-hospitalized patients whose symptoms recurred due to irregular use of drugs.Conclusion:1.Autoimmune hepatitis is predominant in women,more than 40 years old,and its early symptoms lack specificity.About thirty percent of the patients are in the stage ofliver cirrhosis at the time of diagnosis,and this has no significant correlation with whether or not they are combined with PBC.2.AIH-1 is the most common type in AIH patients,AIH is associated with PBC and other autoimmune diseases.The proportion of AIH-PBC overlap syndrome is higher in clinical patients,and Sjogren’s syndrome is the most common in extrahepatic autoimmune diseases.3.The levels of ALP,GGT and IgM in patients with AIH-PBC overlap syndrome were higher than those in AIH group,and the positive rate of AMA-M2,anti-GP210 and anti-SP100 antibody was higher than that in patients with AIH.4.Hepatic histology showed moderate-severe interface hepatitis,lymphocyte plasma cell infiltration,hepatic rosette,combined with PBC patients with more common bile duct destruction changes.5.Only about half of AIH patients use immunosuppressive therapy,of which about 30% are not standardized,and the hospitalization rate for complications of cirrhosis is low after application of immunosuppressant.Early diagnosis and standardized treatment are critical to the prognosis of patients.