Strzepka Jessica, Schwartz Benjamin A, Ritz Ethan M, Aloman Costica, Reau Nancy
Department of Internal Medicine, Rush University Medical Center, Chicago, IL, Department of Internal Medicine, Rush University Medical Center, Chicago, IL.
Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL.
J Clin Gastroenterol. 2024 Jan 1;58(1):91-97. doi: 10.1097/MCG.0000000000001817.
The objective of this study was to characterize an autoimmune hepatitis (AIH)/nonalcoholic fatty liver disease (NAFLD) overlap cohort, determine if they received standard of care treatment, and delineate their outcomes in comparison with patients with AIH or NAFLD alone.
AIH is a relatively rare and heterogeneously presenting liver disease of unknown etiology. NAFLD is a leading cause of liver disease worldwide. AIH treatment includes steroids, which have adverse metabolic effects that can worsen NAFLD. No treatment guidelines are available to mitigate this side on AIH/NAFLD overlap patients. Few studies to date have examined these patients' characteristics, management practices, and outcomes.
A single-center, retrospective chart review study examining biopsy-proven AIH/NAFLD, AIH, and NAFLD patients. Characteristics, treatment, and 1- and 3-year outcomes (all-cause mortality, need for liver transplantation, or decompensated cirrhosis) were evaluated.
A total of 72 patients (36.1% AIH/NAFLD, 34.7% AIH, and 29.2% NAFLD) were included. AIH/NAFLD patients were found to be more often Hispanic/Latino, female, and with lower liver aminotransaminases, immunoglobulin G, and anti-smooth muscle antibody positivity. AIH/NAFLD patients were less likely to receive standard of care treatment. No significant differences in outcomes were seen between AIH/NAFLD and either AIH or NAFLD.
Our study demonstrated that AIH/NAFLD patients have unique characteristics and are less likely to receive standard of care treatment compared with patients with AIH alone. Despite this, no difference in outcomes (all-cause mortality, need for liver transplantation, or decompensated cirrhosis) was seen. Given NAFLD's rising prevalence, AIH/NAFLD cases will likely increase, and may benefit from alternative treatment guidelines to prevent worsening of NAFLD.
本研究的目的是对自身免疫性肝炎（AIH）/非酒精性脂肪性肝病（NAFLD）重叠人群进行特征描述，确定他们是否接受了标准治疗，并与单纯AIH或NAFLD患者相比，描绘出他们的预后情况。
AIH是一种病因不明、相对罕见且表现多样的肝脏疾病。NAFLD是全球肝病的主要病因。AIH的治疗包括使用类固醇，其具有不良代谢效应，可使NAFLD恶化。目前尚无减轻AIH/NAFLD重叠患者这一副作用的治疗指南。迄今为止，很少有研究调查这些患者的特征、管理措施及预后情况。
一项单中心回顾性病历审查研究，纳入经活检证实的AIH/NAFLD、AIH和NAFLD患者。评估其特征、治疗情况以及1年和3年的预后（全因死亡率、肝移植需求或失代偿期肝硬化）。
共纳入72例患者（36.1%为AIH/NAFLD，34.7%为AIH，29.2%为NAFLD）。发现AIH/NAFLD患者更常为西班牙裔/拉丁裔、女性，且肝转氨酶、免疫球蛋白G及抗平滑肌抗体阳性率较低。AIH/NAFLD患者接受标准治疗的可能性较小。AIH/NAFLD与AIH或NAFLD患者在预后方面无显著差异。
我们的研究表明，与单纯AIH患者相比，AIH/NAFLD患者具有独特的特征，接受标准治疗的可能性较小。尽管如此，在预后（全因死亡率、肝移植需求或失代偿期肝硬化）方面未见差异。鉴于NAFLD患病率不断上升，AIH/NAFLD病例可能会增加，或许可从预防NAFLD恶化的替代治疗指南中获益。
