Clinical Features Of Autoimmune Liver Disease

Objective To contrast the clinical manifestations of Autoimmune hepatitis(AIH)and Primary biliary cholangitis(PBC),to make for the early diagnosis and differentiation of the two diseases.Methods We selected Patients that were diagnosed AIH or PBC and hospitalized in the Department of Gastroenterology,Union Hospital of Tongji Medical College,Huazhong University of Science and Technology from January 2010 to February 2018.We collected the general conditions(including sex,age,symptoms and signs,comorbidities)?serum biochemistry(blood test?Coagulation and liver profiles)?immunological indices(autoantibodies,immunoglobulin,erythrocyte sedimentation rate(ESR)and complement)?liver pathology and Fibro touch results,analysis and compare the different characteristics of AIH and PBC patients.The normal distributed continuous data between the two groups was compared by independent sample t test;Mann-Whitney U test was used to compare the continuous date skewed distribution between the two groups.The categorical data,however,was compared between the two groups using the chi-square test or the Fisher's exact test(when the number of cases was zero).The use of Fibro touch to distinguish liver fibrosis was analyzed by Receiver Operating Characteristic(ROC)analysis and confirm the sensitivity?specificity ?the area under the ROC.Results 1.83 patients with AIH and 108 patients with PBC were collected,we found most of the patients were female with the peak age of 40-60 years old.2.General conditions and comorbidities: the clinical features of AIH and PBC had no obviously specification.The main symptoms and signs of them were: fatigue,anorexia,jaundice,abdominal distension,and the patients with anorexia symptoms in the AIH group were more than that in the PBC group(25.3% vs 13.9%,?2=6.52,P=0.011).In addition,the proportion of patients with cirrhosis(59.0% vs 40.7%,?2 = 6.23,P=0.012)and the proportion of patients with rheumatic diseases(28.9% vs 14.8%,?2=5.64,P=0.018)were also higher in the AIH group than that in PBC group.3.Serum biochemistry and immunological indices: There was no significant difference in alanine aminotransferase(ALT)and aspartate aminotransferase(AST)level between AIH group and PBC group(P>0.05),but the level of alkaline phosphatase(ALP),?-glutamyl transferase(GGT),Platelet count(PLT)and erythrocyte sedimentation rate(ESR),complement C3,Immunoglobulin M(Ig M)in AIH group was lower than that of the PBC group(P<0.05),while the levels of Immunoglobulin G(Ig G),prothrombin time(PT)and international normalized ratio(INR)were higher than those of the PBC group,with statistically significant differences(P<0.05).Meanwhile,in the PBC group,the positive rate of anti-mitochondrial antibody M2(78.8% vs 14.8%),anti-BCOADA-E2PDC-E2OGDC-E2 antibody(anti-3E antibody)(75.0% vs 31.6%)and anti-gp210 antibody(46.4% vs 53%)was higher than that in the AIH group,and the difference was statistically significant(P<0.05).4.As for the characteristics of liver histology,AIH is mainly characterized by the interfacial hepatitis,while the PBC is characterized by bile duct injury(mainly including small cholangitis,bile duct loss,biliary granuloma,and reactive hyperplasia of small bile duct).(P value <0.05)5.Fibro touch is used to distinguish liver fibrosis(S?2,S>2)in patients between AIH and PBC group,and was more valuable in AIH than in PBC(areas under ROC curve: 0.949 vs 0.673).Conclusion 1.Both AIH and PBC are women in major,and their clinical manifestations are non-specific.2.At the time of admission in hospital,serum biochemistry,immunoglobulin levels,ESR,complement levels and antibody types,liver pathology are different,and can be used for differential diagnosis of the two.In addition,Fibro touch can be used to distinguish liver fibrosis(S?2;S>2)in AIH patients,anti-3E antibodies can be used to support the diagnosis of PBC.