慢性肝病中修订的国际自身免疫性肝炎评分，包括自身免疫性肝炎/重叠综合征以及合并其他肝脏疾病的自身免疫性肝炎。
The revised international autoimmune hepatitis score in chronic liver diseases including autoimmune hepatitis/overlap syndromes and autoimmune hepatitis with concurrent other liver disorders.
作者信息
Papamichalis Panagiotis A, Zachou Kalliopi, Koukoulis George K, Veloni Aikaterini, Karacosta Efthimia G, Kypri Lampros, Mamaloudis Ioannis, Gabeta Stella, Rigopoulou Eirini I, Lohse Ansgar W, Dalekos George N
机构信息
Dept. of Medicine, Research Laboratory of Internal Medicine, Medical School, University of Thessaly, 22 Papakiriazi str, Larissa 41222, Greece.
出版信息
J Autoimmune Dis. 2007 Jun 29;4:3. doi: 10.1186/1740-2557-4-3.
BACKGROUND
We conducted a study in order to determine the usefulness and diagnostic value of International Autoimmune Hepatitis Group (IAHG) score in non-autoimmune hepatitis (AIH) hepatic disorders as well as in AIH/overlap syndromes and in cases with coexistence of AIH and other liver diseases.
METHODS
We applied the IAHG score in 423 patients with liver diseases excluding patients with AIH, AIH/overlap syndromes and AIH with concurrent other liver disease namely, patients with chronic hepatitis B (n = 109), chronic hepatitis C (n = 95), chronic hepatitis D (n = 4), alchoholic liver disease (n = 28), non-alcoholic fatty liver disease (n = 55), autoimmune cholestatic liver diseases (n = 77), liver disorders of undefined origin (n = 32) and with miscellaneous hepatic disorders (n = 23). 24 patients with AIH associated with any kind of liver disorder including 10 patients with AIH/overlap syndromes and 14 AIH with concurrent other liver disease were also investigated. 43 patients with AIH consisted the control group.
RESULTS
The specificity of the score was 98.1% while the sensitivity in unmasking AIH in patients with either AIH/overlap syndromes or AIH with concurrent other liver diseases was only 50% and 78.6%. In the binary logistic regression model, the presence of other autoimmune diseases (p < 0.001), the total histological score (p < 0.001) and positivity for autoantibodies (p < 0.05) were identified as independent predictors for the presnce of AIH/ovea syndromes o AI with concurren other liver diseass.
CONCLUSION
The IAHG scoring system has very good specificity for excluding AIH in patients with chronic liver diseases but not that sensitivity in order to unmask AIH/overlap syndromes or AIH with concurrent other liver diseases. The presence of other autoimmune diseases or autoantibody markers in the absence of hepatitis viral markers should alarm physicians for the possible presence of AIH either as "pure" AIH or in association with other liver disorders (AIH/overlap syndromes or AIH with concurrent other liver diseases). Under these conditions, liver histology seems essential and it must always be included in the work up of hepatic patients.
背景
我们开展了一项研究，以确定国际自身免疫性肝炎小组（IAHG）评分在非自身免疫性肝炎（AIH）肝脏疾病、AIH/重叠综合征以及AIH与其他肝脏疾病并存病例中的实用性和诊断价值。
方法
我们将IAHG评分应用于423例肝病患者，这些患者排除了AIH、AIH/重叠综合征以及AIH合并其他肝病的患者，即慢性乙型肝炎患者（n = 109）、慢性丙型肝炎患者（n = 95）、慢性丁型肝炎患者（n = 4）、酒精性肝病患者（n = 28）、非酒精性脂肪性肝病患者（n = 55）、自身免疫性胆汁淤积性肝病患者（n = 77）、病因不明的肝脏疾病患者（n = 32）以及其他肝脏疾病患者（n = 23）。还对24例与任何类型肝脏疾病相关的AIH患者进行了研究，其中包括10例AIH/重叠综合征患者和14例合并其他肝病的AIH患者。43例AIH患者组成了对照组。
结果
该评分的特异性为98.1%，而在AIH/重叠综合征患者或合并其他肝病的AIH患者中揭示AIH的敏感性仅为50%和78.6%。在二元逻辑回归模型中，其他自身免疫性疾病的存在（p < 0.001）、组织学总评分（p < 0.001）和自身抗体阳性（p < 0.05）被确定为AIH/重叠综合征或合并其他肝病的AI存在的独立预测因素。
结论
IAHG评分系统在排除慢性肝病患者中的AIH方面具有非常好的特异性，但在揭示AIH/重叠综合征或合并其他肝病的AIH方面敏感性不足。在没有肝炎病毒标志物的情况下，其他自身免疫性疾病或自身抗体标志物的存在应提醒医生可能存在“单纯”AIH或与其他肝脏疾病相关的AIH（AIH/重叠综合征或合并其他肝病的AIH）。在这些情况下，肝脏组织学似乎至关重要，并且必须始终纳入肝病患者的检查中。
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