Abstract: Objective To investigate the relationship between serum ferritin level and liver fibrosis in patients newly diagnosed with autoimmune hepatitis (AIH).Methods A total of 92 patients with AIH who had undergone liver biopsy before receiving immunosuppressive therapy from January 2012 to June 2022 were reviewed. The patients consisted of 15 males and 77 females, with a mean age of 54.0±11.3 years. The assessment of hepatic fibrosis stages was based on Batts-Ludwig scoring system, in which F3 and F4 stages were defined as advanced hepatic fibrosis, and F0-F2 stages were non-advanced hepatic fibrosis. The clinical data of the two groups and the correlation among the data were compared, and the factors that affect the advanced hepatic fibrosis of AIH were analyzed.Results Based on the results of liver biopsy, the patients were divided into non-advanced fibrosis group (n=57) and advanced fibrosis group (n=35). In AIH patients, the age, IgG, TBil, PT, ferritin and TSI of non-advanced fibrosis group were (51.0±11.8) years old, 14.9(12.8, 18.9)g/L, 17.1(11.6, 32.7)μmol/L, (12.2±1.0)s, 124.3(44.6, 305.4)μg/L and 33.2(23.0, 57.8)%, respectively, which were significantly lower than those in advanced hepatic fibrosis group [(58.1±9.3) years, 18.5(15.8, 24.2)g/L, 28.2(15.7, 92.7)μmol/L, (13.9±1.2)s, 352.7(183.0, 740.6)μg/L and 55.0(41.2, 69.8)%, P<0.05]. While in the non-advanced fibrosis group, Alb, PLT, transferrin, UIBC and TIBC [(41.0±4.8) g/L, (210.4±36.5) × 10⁹/L, 2.7(2.3, 3.2)g/L, 39.0(23.4, 51.2) and 64.0(56.5, 71.0)]μmol/L were significantly higher than those of advanced hepatic fibrosis group [(38.1±5.1) g/L, (122.3±23.5) × 10⁹/L, 2.4(2.1, 2.8)g/L, 25.1(16.3, 31.4)μmol/L and 55.6 (50.6, 60.8)μmol/L, P<0.05]. Correlation analysis showed that serum iron was positively correlated with ferritin and TSI (r=0.44, 0.93) (P<0.05), and negatively correlated with transferrin, UIBC and TIBC (r=-0.44, -0.82, -0.25) (P<0.05). Serum iron, ferritin and TSI were positively correlated with age, TBil and hepatic fibrosis stage (r=0.30, 0.49, 0.24; 0.34, 0.39, 0.40; 0.37, 0.52, 0.29) (P<0.05), while transferrin, UIBC and TIBC were negatively correlated with age, TBil and fibrosis stage (r=-0.41, -0.22, -0.24; -0.38, -0.52, -0.94; -0.36, -0.25, -0.48, P<0.05). Serum iron, ferritin and TSI were positively correlated with ALT and AST (r=0.34, 0.45; 0.42, 0.47; 0.33, 0.45) (P<0.05), while UIBC was negatively correlated with ALT and AST (r=-0.31, -0.40) (P<0.05); serum iron and TSI were negatively correlated with Alb and PLT (r=-0.39, -0.20) (P<0.05), while transferrin, UIBC and TIBC were positively correlated with Alb and PLT (r=0.35, 0.34; 0.53, 0.33; 0.40, 0.39) (P<0.05); there was a positive correlation between TSI and PT (r=0.23) (P<0.05), and a negative correlation between TIBC and PT (r=-0.22) (P<0.05). Multivariate analysis showed that IgG, PLT, PT and ferritin were independent factors to predict advanced liver fibrosis in patients with AIH, and the odds ratios (OR)(95%CI) were 1.10 (1.03~1.21), 0.98 (0.97~0.99), 1.73 (1.16~2.68) and 1.02 (1.01~1.04), respectively.Conclusion The increased serum ferritin level in newly diagnosed AIH patients is independently related to advanced hepatic fibrosis.

Key words: Autoimmune hepatitis, Serum ferritin, Liver fibrosis