Clinical manifestations and histopathological features of liver failure caused by autoimmune hepatitis

Abstract

Abstract: Objective To analyze the clinical manifestations and histopathological features of autoimmune hepatitis-related liver failure (AIH-LF) patients with different clinical outcomes.Methods Twenty-three patients with AIH-LF admited in the first people’s hospital of Yancheng city from January 2010 to June 2022 were collected retrospectively, including 3 males and 20 females, aged 44 (30, 53) years. According to the condition, they were divided into an AIH-LF remission group and a progression group. The clinical data and histopathological features of the two groups of patients were compared. Results In terms of clinical data, the duration of AIH patients in the remission group was more than 6 months, and the number of cases and the time interval of the diagnosis of liver failure was 4 cases (33.3%) and 11 (2, 17) months, which were significantly lower than those in the progressive group [7 cases (63.6%) and 23 (4, 51) months, P<0.05]. There were 8 cases (66.7%) and 2 cases (18.2%) of subacute, acute on chronic liver failure in AIH-LF remission group, compared with 2 cases (18.2%) and 8 cases (72.7%) in AIH-LF progression group, the difference was statistically significant (P<0.05). There were 1 case (8.3%) and 5 cases (45.4%) of cirrhosis in AIH-LF remission and progression group, and the difference was statistically significant (P<0.05). 9 patients (75.0%) in AIH-LF remission group were treated with steroid hormone, which was significantly higher than that in AIH-LF progression group [3 patients (27.3%), P<0.05]. Anorexia, infection, renal insufficiency and gastrointestinal bleeding in AIH-LF remission group were 3 cases (25.0%), 4 cases (33.3%), 0 (0) and 0 (0), respectively, which were significantly lower than those in AIH-LF progression group [8 cases (72.7%), 9 cases (81.8%), 4 cases (36.4%) and 4 cases (36.4%), P<0.05]. The levels of AFP in the remission and progression group of AIH-LF were 104 (42, 176) ng/mL and 55 (4, 122) ng/mL, and the difference was statistically significant (P<0.05). The number of IgG positive cases in AIH-LF remission group was 1 case (8.3%), which was significantly lower than that in AIH-LF progression group [5 cases (45.4%), P<0.05]. As for the histopathological features, there were 10 cases (83.3%) of interfacial hepatitis in AIH-LF remission group, which were significantly higher than those of 4 cases (36.4%) in AIH-LF progression group [P<0.05]. The cases of bile duct injury and F3-F4 hepatic fibrosis in AIH-LF remission group were 1 case (8.3%) and 2 cases (16.7%), respectively, which were significantly lower than those of 6 cases (54.5%) and 6 cases (54.5%) in the AIH-LF progression group [P<0.05]. Conclusion Although the incidence of AIH-LF is not high, it causes high mortality. Different clinical features indicate different clinical outcomes, which is of great significance for clinical work. Patients with advanced AIH-LF have a long course of AIH and liver cirrhosis, often accompanied by anorexia, infection, renal insufficiency, gastrointestinal bleeding and other symptoms. At the same time, histopathology is characterized by bile duct injury and significant liver fibrosis.

Key words: Autoimmune hepatitis, Liver failure, Steroid, Hepatic fibrosis

WANG Shu-shu, WANG Shu-ren. Clinical manifestations and histopathological features of liver failure caused by autoimmune hepatitis[J]. Chinese Hepatolgy, 2023, 28(9): 1037-1040.

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