Comparison Of Clinical Features Between Antibody-positive And Antibody-negative Autoimmune Hepatitis In Chinese Patients

Background Circulating autoantibodies is one of the important features of Autoimmune hepatitis(AIH).The goal of this retrospective study was to determine whether the presence of autoantibodies in patients with AIH correlated with clinical presentation,histologic findings and progression,so that we can define the clinical features of Chinese patients with autoantibody-negative AIH and to refine the diagnosis and management of these atypical patients in a single Chinese center.Methods A retrospective evaluation of 82 Chinese patients with AIH was performed.Patients meeting comprehensive criteria with the absence of classical autoantibodies were defined as autoantibody-negative AIH,otherwise it was autoantibody-positive AIH.The clinical characteristics,disease severity and prognosis of the two groups were analyzed.Results In total,13(17.1%)of the 82 patients with AIH were autoantibody-negative.The general status between the classical and autoantibody-negative patients were not significantly different(p>0.05).Before treatment,serum immune globulin(IgG)and globulin(GLB)levels of antibody-negative AIH patients were significantly lower than those of antibody-positive AIH ones(respectively 15.0 g/L vs 21.5 g/L,30.0 g/L vs 40.7 g/L),both with statistically significant differences(p<0.01).The absolute value and proportion of peripheral blood lymphocytes in the antibody-positive group were significantly lower than those in the antibody-negative group(p<0.05).But,there were no significant differences in other biochemical and immune indicators,liver histology,abdominal imaging and disease progression between the two groups(p>0.05).According to the comprehensive criteria,The two groups scored an average of 16.5 and 16 points,respectively.While with the simplified criteria,the score of antibody-negetive group is significant lower than the antibody-positive group(6.9 points vs 4.5 points,p<0.001).Conclusion.Classical autoantibodies play an important role in the diagnosis of AIH,but it cannot be used to predict disease activity,severity and prognosis.Antibody-negative AIH has atypical clinical features and is easy to miss diagnosis.It is recommended to perform liver biopsy and use comprehensive criteria to diagnose the disease antibody-negative patients,immunosuppressive therapy should be adopted for these patients meeting diagnostic criteria.