Hurlburt Kathy J, McMahon Brian J, Deubner Heike, Hsu-Trawinski Barbara, Williams James L, Kowdley Kris V
Viral Hepatitis Program, Alaska Native Medical Center, Anchorage 99508, USA.
Am J Gastroenterol. 2002 Sep;97(9):2402-7. doi: 10.1111/j.1572-0241.2002.06019.x.
There is limited information on the prevalence of autoimmune liver disease in nonwhite populations. We conducted a population-based study on the prevalence of autoimmune liver diseases in Alaska natives.
Clinical records from 1984 to July, 2000 were reviewed to identify Alaska natives with autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis, autoimmune cholangitis, and overlap syndromes of two of the above. AIH was defined as definite or probable, based on criteria established by the International Autoimmune Hepatitis Group. The diagnosis of PBC was based on a positive antimitochondrial antibody of > or = 1: 40, biochemical evidence of cholestasis, and compatible liver biopsy. Autoimmune cholangitis was defined as PBC but without a positive antimitochondrial antibody. Primary sclerosing cholangitis was diagnosed on the basis of cholangiogram.
Seventy-seven patients with possible autoimmune liver disease were identified. Of these, 42 had definite and seven probable AIH. At presentation, 34.7% of patients with AIH presented with acute icteric hepatitis, and 65.3% were asymptomatic. Persons presenting with mild or no symptoms were more likely to have moderate to severe fibrosis on liver biopsy than those presenting with jaundice. Eighteen persons were diagnosed with PBC, five with autoimmune cholangitis, five with overlap syndrome, and none with primary sclerosing cholangitis. The combined point prevalence of AIH Alaska natives was 42.9/100,000 (95% CI = 31-57.7). The prevalence of PBC was 16/100,000 (95% CI = 12.9-25.4).
This population-based study demonstrates that the prevalence rates of AIH and PBC in Alaska natives are comparable with reported rates in other populations.
关于非白人人群自身免疫性肝病患病率的信息有限。我们针对阿拉斯加原住民自身免疫性肝病的患病率开展了一项基于人群的研究。
回顾了1984年至2000年7月的临床记录，以确定患有自身免疫性肝炎（AIH）、原发性胆汁性肝硬化（PBC）、原发性硬化性胆管炎、自身免疫性胆管炎以及上述两种疾病重叠综合征的阿拉斯加原住民。根据国际自身免疫性肝炎小组制定的标准，AIH被定义为确诊或疑似。PBC的诊断基于抗线粒体抗体阳性（≥1:40）、胆汁淤积的生化证据以及相符的肝活检结果。自身免疫性胆管炎被定义为符合PBC但抗线粒体抗体阴性。原发性硬化性胆管炎根据胆管造影进行诊断。
共识别出77例可能患有自身免疫性肝病的患者。其中，42例确诊为AIH，7例疑似AIH。在初次就诊时，34.7%的AIH患者表现为急性黄疸型肝炎，65.3%无症状。与出现黄疸的患者相比，症状较轻或无症状的患者肝活检时更易出现中度至重度纤维化。18例被诊断为PBC，5例为自身免疫性胆管炎，5例为重叠综合征，无原发性硬化性胆管炎患者。阿拉斯加原住民AIH的合并时点患病率为42.9/10万（95%CI = 31 - 57.7）。PBC的患病率为16/10万（95%CI = 12.9 - 25.4）。
这项基于人群的研究表明，阿拉斯加原住民中AIH和PBC的患病率与其他人群报告的患病率相当。
