Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland.
Clin Gastroenterol Hepatol. 2011 Jan;9(1):57-63. doi: 10.1016/j.cgh.2010.07.016. Epub 2010 Aug 17.
BACKGROUND & AIMS: The importance of histologic analysis of biopsy samples in the diagnosis and management of patients with autoimmune hepatitis (AIH) is unclear.
Patients with AIH were identified from a 10-year database. Individuals with overlap syndromes and decompensated liver disease were excluded. The proportion of patients who fulfilled the new simplified criteria for AIH was calculated.
A total of 257 patients (203 female) with a median age of 52 years (interquartile range, 39-63 y) were diagnosed with AIH. Overall, 183 of 257 (71%) were positive for antinuclear antibodies, 116 (45%) had positive smooth muscle antibodies, and 29 of 257 (11%) were seronegative. A total of 250 (97%) patients had increased levels of autoantibodies and/or γ-globulins. In 95% (243 of 257 cases), the histology was compatible with AIH whereas 5% (14 cases) had atypical histology. Overall, 77% had a score of at least 6, indicating probable or definite AIH according to most recent criteria; 22% were diagnosed with AIH with less than 6 points and 1 patient had nonalcoholic steatohepatitis based on biopsy analysis. Immunosuppression occurred in 93% of patients. Patients with atypical versus compatible histology were similar in terms of seronegativity or γ-globulins; 86% (12 of 14) received immunosuppressive therapy despite atypical histology.
Most patients with features of AIH, based on laboratory analyses, are likely to have a compatible liver histology. Few patients have atypical histology and these findings have little impact on patient management. These findings indicate biopsy samples might not need to be collected from patients who meet other clinical criteria for AIH.
肝活检组织学分析在自身免疫性肝炎（AIH）患者的诊断和治疗中的重要性尚不清楚。
从一个 10 年的数据库中确定 AIH 患者。排除重叠综合征和肝功能失代偿患者。计算符合 AIH 简化新标准的患者比例。
共诊断 257 例（203 例女性）AIH 患者，中位年龄 52 岁（四分位距 39-63 岁）。总体而言，257 例患者中 183 例（71%）抗核抗体阳性，116 例（45%）平滑肌抗体阳性，29 例（11%）抗体阴性。250 例（97%）患者的自身抗体和/或γ球蛋白水平升高。95%（243 例）患者的组织学符合 AIH，5%（14 例）为非典型组织学。总体而言，77%的患者评分至少为 6 分，根据最新标准提示可能或明确的 AIH；22%的患者评分<6 分，1 例患者根据肝活检分析诊断为非酒精性脂肪性肝炎。93%的患者接受了免疫抑制治疗。组织学非典型与符合的患者在抗体阴性或γ球蛋白方面相似；尽管组织学非典型，14 例患者中有 12 例仍接受免疫抑制治疗。
根据实验室分析，大多数具有 AIH 特征的患者可能具有符合 AIH 的肝组织学表现。少数患者有非典型组织学表现，但这些发现对患者管理的影响不大。这些发现表明，对于符合 AIH 其他临床标准的患者，可能不需要采集肝活检样本。
