Department of Gastroenterology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Clin Res Hepatol Gastroenterol. 2012 Apr;36(2):185-8. doi: 10.1016/j.clinre.2011.08.011. Epub 2011 Oct 4.
To investigate whether liver diseases other than autoimmune hepatitis (AIH) can present with the typical features of AIH, and to determine the impact of liver biopsy for differentiating AIH from these conditions.
The study used data collected at Hacettepe university hospital and numune education and research hospital from 2007 to 2011. The clinical, laboratory and histological findings of patients diagnosed with non-alcoholic steatohepatitis, drug-induced liver injury, primary biliary cirrhosis, primary sclerosing cholangitis, hemochromatosis and Wilson's disease were evaluated to identify those who presented with the typical features of AIH, but had no liver histology compatible with or suggestive of AIH.
A total of 386 patients were evaluated, and four patients with typical features of AIH were identified. Three patients were positive for antinuclear antibodies, and one was positive for smooth muscle antibodies. Also, all four had increased levels of immunoglobulin G, and aminotransferase levels that were five times above the upper limit. According to simplified AIH criteria, all patients had a score of 6, indicating probable AIH. On liver biopsy, two patients were diagnosed with non-alcoholic steatohepatitis, another with drug-induced liver injury and a further one with primary biliary cirrhosis.
Liver diseases other than AIH can present with the typical laboratory features of AIH and, without liver biopsy, it is difficult to distinguish AIH than these conditions. Although histological findings have little impact on patients' management and outcomes, for a definitive diagnosis of AIH, liver biopsy is essential and should be performed in all patients in whom it is suitable and not contraindicated.
研究非自身免疫性肝炎（AIH）的肝脏疾病是否具有 AIH 的典型特征，并确定肝活检对区分 AIH 与这些疾病的影响。
该研究使用了 2007 年至 2011 年在哈塞特佩大学医院和努姆内教育和研究医院收集的数据。评估了诊断为非酒精性脂肪性肝炎、药物性肝损伤、原发性胆汁性肝硬化、原发性硬化性胆管炎、血色病和威尔逊病的患者的临床、实验室和组织学发现，以确定那些具有 AIH 典型特征但没有肝组织学与 AIH 相符或提示 AIH 的患者。
共评估了 386 例患者，发现 4 例具有 AIH 的典型特征。3 例抗核抗体阳性，1 例平滑肌抗体阳性。此外，所有 4 例患者的免疫球蛋白 G 水平升高，氨基转移酶水平高于上限 5 倍。根据简化的 AIH 标准，所有患者的评分均为 6，提示可能为 AIH。肝活检显示，2 例诊断为非酒精性脂肪性肝炎，另 1 例为药物性肝损伤，还有 1 例为原发性胆汁性肝硬化。
非 AIH 的肝脏疾病可能具有 AIH 的典型实验室特征，在没有肝活检的情况下，很难将 AIH 与这些疾病区分开来。尽管组织学发现对患者的治疗和结局影响不大，但为了明确 AIH 的诊断，肝活检是必要的，应在所有适合且无禁忌症的患者中进行。
