Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, 40138, Bologna, Italy.
Center for the Study and Treatment of Autoimmune Diseases of the Liver and Biliary System, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italy.
Virchows Arch. 2021 Nov;479(5):937-945. doi: 10.1007/s00428-021-03122-5. Epub 2021 Jun 30.
Liver biopsy is crucial for the diagnosis of autoimmune hepatitis (AIH), and new reproducible histological criteria would be highly desirable, especially in acute-on-chronic cases. The aims of the present study were (i) to evaluate the AIH histopathological criteria as a function of the time and modality of AIH onset, and (ii) to validate the count of apoptotic bodies in the portal tracts as a histopathological criterion for AIH diagnosis. Sixty-five patients were retrospectively enrolled: 20 underwent biopsy for the first diagnosis and 45 had a previous histological AIH diagnosis. Biopsies were revised, and all histological variables were collected, including the lymphocytic apoptotic bodies in the portal tracts. Clinical and serological data were revised as well. First-diagnosis patients showed a higher grade of inflammation (p = 0.001), but also worse portal fibrosis (p = 0.001). The apoptotic body count was higher in first-diagnosis patients than in follow-up patients (p = 0.002), and it was strongly correlated to inflammation. Using the apoptotic body count among the simplified AIH score variables, the first-biopsy patients in the "definite" category rose from 42 to 68%. Our results confirm the histopathological criteria proposed by the literature and introduce the count of portal apoptotic bodies for the diagnosis of active AIH, especially in first biopsies without other classic features, as well as in AIH diagnostic score, albeit future studies are required to find a definite cutoff.
肝活检对于自身免疫性肝炎（AIH）的诊断至关重要，人们非常希望有新的可重复的组织学标准，尤其是在慢性急性发作的病例中。本研究的目的是：（i）评估 AIH 组织病理学标准是否与 AIH 发病的时间和方式有关；（ii）验证门脉区凋亡小体计数作为 AIH 诊断的组织病理学标准。共回顾性纳入 65 例患者：20 例为首次诊断活检，45 例有先前的组织学 AIH 诊断。对活检进行重新评估，并收集了所有组织学变量，包括门脉区的淋巴细胞凋亡小体。同时也对临床和血清学数据进行了重新评估。首次诊断患者表现出更高的炎症程度（p=0.001），但也有更严重的门脉纤维化（p=0.001）。首次诊断患者的凋亡体计数高于随访患者（p=0.002），且与炎症强烈相关。在简化的 AIH 评分变量中使用凋亡体计数，“明确”类别的首次活检患者从 42%增加到 68%。我们的结果证实了文献中提出的组织病理学标准，并提出了门脉凋亡小体计数用于诊断活动期 AIH，特别是在没有其他经典特征的首次活检中，以及在 AIH 诊断评分中，尽管需要进一步研究来确定明确的截止值。
