Analysis of clinical and pathological features of acute autoimmune hepatitis

Abstract

Abstract: Objective To analyze clinical and pathological features of acute autoimmune hepatitis.Methods 74 patients with AIH who were hospitalized and underwent liver biopsy from January 2012 to June 2022 in Jiangbin Hospital of Guangxi were enrolled. The patients included 13 males and 61 females, with a mean age of 53.2±8.7 years. The diagnosis of acute AIH needed to meet at least one of the following conditions: total bilirubin (TBil) ≥ 85.5 μmol/L; transaminase level (ALT/AST) ≥ 10 × the upper limit of normal value. The baseline data, laboratory indexes and pathological manifestations were analyzed.Results There were 32 cases of acute AIH and 45 cases of chronic AIH in 77 patients. There were no significant differences in sex, age, IAIHG score, extrahepatic autoimmune diseases and onset time between the two groups (P>0.05). However, patients with acute AIH had a significantly higher proportion of jaundice, anorexia, and yellow urine compared to patients with chronic AIH (P<0.05). The positive rates of TBil, ALT, AST, PT, INR, IgG and ANA titers in patients with acute AIH>1∶100 were 83.4 (47.8, 192.8) μmol/L, 237 (141, 352) U/L, 292 (168, 357) U/L, 15.1 (13.6, 16.5) s, 1.3 (1.1, 1.4), 30.2 (21.4, 33.3) g/L and 27 cases (84.4%), respectively, which were significantly higher than those in patients with chronic AIH [24.0 (13.2, 47.8) μmol/L, 44 (23, 94) U/L, 56 (34, 97) U/L, 12.8(11.7, 13.7) s, 1.1 (1.0, 1.1), 21.6 (17.6, 24.3) g/L and 23 cases (51.1%), P<0.05]. The Alb of patients with acute and chronic AIH was (34.2±3.0) g/L and (40.2±3.1) g/L, and the difference was statistically significant (P<0.05). Acute AIH was mainly characterized by acute hepatitis in histopathology. There were significant differences in inflammation grade, lobular inflammation, interfacial hepatitis, rosette, lymphocytes around portal vein, plasma cells, neutrophils, bile duct injury and lobular neutrophils between acute and chronic AIH patients (P<0.05), but there was no significant difference in liver fibrosis stage between them (P>0.05).Conclusion Acute AIH is mainly characterized by acute hepatitis. Clinical manifestations and serological examination can preliminarily distinguish acute AIH from chronic AIH. In histopathology, besides high inflammatory grade, interfacial hepatitis, rosette and inflammatory cells around the portal vein, acute AIH is prone to bile duct injury. Therefore, long-term follow-up should be paid attention to.

Key words: Autoimmune hepatitis, Inflammation grading, Hepatic fibrosis, Bile duct injury

ZHENG Mu-yang, HU Hai, FAN Xian-wen. Analysis of clinical and pathological features of acute autoimmune hepatitis[J]. Chinese Hepatolgy, 2023, 28(8): 953-956.

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