The Clinical And Pathological Features Of AIH With NAFLD And The Study Of Non-invasive Markers To Assess The Degree Of Liver Fibrosis Of AIH

Objective To elucidate the clinical and pathological features of autoimmune hepatitis(AIH)or AIH overlapping primary biliary cirrhosis(PBC)with nonalcoholic fatty liver disease(NAFLD).Methods We evaluated patients diagnosed with AIH or AIH overlapping PBC by liver biopsy in the ninth people's hospital affiliated to Shanghai jiaotong university school of medicine from 2006 to 2018.According to the presence or absence of hepatic steatosis,patients were divided into NAFLD group and non-NAFLD group.Results 67 subjects(12 male,55 female)were included in this study,the total prevalence of NAFLD was 20.9%.Compared to patients without NAFLD,those who were diagnosed concurrently with AIH or AIH overlapping PBC and NAFLD has the following characteristics: 1.Lower proportion of females 2.older age 3.Lower alkaline phosphatase level 4.No significant difference in degree of liver fibrosis and inflammatory activity between the two groups 5.No significant difference in triglyceride level between the two groups.Conclusion AIH or AIH overlapping PBC patients with NAFLD have different characteristics from those without NAFLD.Understanding these differences is crucial for the correct diagnosis and treatment of autoimmune liver disease patients with NAFLD.Objective Search after some markers with no invasion to evaluate the liver fibrosis stage in autoimmune hepatitis(AIH)patients.Methods 45 patients diagnosed with AIH by liver biopsy in the ninth people's hospital affiliated to Shanghai jiaotong university school of medicine from 2006 to 2018 and 47 healthy controls were recruited to this retrospective study.All subjects were performed complete blood count and liver function tests.And AIH patients were divided into “no/minimal fibrosis” and “advanced fibrosis” group based on liver biopsy.Results 1.Compared with healthy controls,AIH patients had significant higher monocytes,mean corpuscular volume(MCV),red blood cell distribution widthcoefficient variation(RDW-CV),red blood cell distribution width-standard deviation(RDW-SD),neutrophil to lymphocyte ratio(NLR),RDW-CV to PLT ratio(RDWCV/PLT),RDW-SD to PLT ratio(RDW-SD/PLT),TBIL,DBIL,GLB,ALT,AST,GGT,ALP,GGT to PLT ratio(GPR).2.AIH patients had lower WBC,neutrophils,lymphocytes,RBC,hemoglobin(HGB),hematocrit(HCT),lymphocyte to monocyte ratio(LMR),TP,ALB and AST to ALT ratio(AAR).3.Patients with advanced fibrosis had remarkable higher RDW-CV,RDW-SD,RDW-CV/PLT,RDW-SD/PLT,AAR,FIB-4 and lower RBC,PLT,plateletcrit(PCT)and ALB compared with no/minimal fibrosis group.4.Logistic regression analysis showed that RDW-SD/PLT was an independent risk factor of advanced fibrosis with OR(95%CI)of 2.647(1.383-5.170).ROC analysis revealed that RDW-SD,RDW-CV/PLT,RDW-SD/PLT,FIB-4 and AAR had an area under the ROC curve(AUC)above 0.700 and the RDW-SD/PLT had the largest AUC of 0.785 with a cut-off value of 0.239.Conclusion RDW-SD,RDW-CV/PLT,RDW-SD/PLT,FIB-4 and AAR were excellent noninvasive biomarkers and RDW-SD/PLT was an independent risk factor for predicting advanced fibrosis in AIH patients.