Department of Gastroenterology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Room No.717, 7th Floor, OPD Building, Mumbai, 400 008, India.
Indian J Gastroenterol. 2024 Apr;43(2):443-451. doi: 10.1007/s12664-023-01474-1. Epub 2024 Mar 8.
Non-A-E hepatitis (NAEH) not leading to acute liver failure (ALF) is poorly documented. The objective was to compare clinical and laboratory features of uncomplicated acute NAEH with acute viral (AVH) and autoimmune hepatitis (AIH) and histopathology in NAEH and AIH.
Cases of hepatocellular jaundice were included. These were grouped into AVH, AIH and NAEH based on clinical, laboratory and, when indicated, liver biopsy findings. NAEH and AIH were followed up at three months.
Of 336 patients with hepatocellular jaundice, 15 (5%) were NAEH, 25 (7%) acute AIH and 45 (14%) AVH. Among NAEH patients, seven (46.7%) were males with a mean age of presentation 39 years. Jaundice (100%) was the most common presentation of NAEH. Peak bilirubin was 10.7 mg/dL. Peak aspartate and alanine aminotransferase (AST, ALT) were 512 and 670 U/L. Five (33.3%) patients had positive anti-nuclear antibody and one had anti-smooth muscle antibody. Mean immunoglobulin G (IgG) levels were 1829. On liver biopsy, all had ballooning degeneration, four (26.7%) had mild and three (20%) moderate interface hepatitis, four (26.7%) mild lymphoplasmacytic infiltrate, one (6.7%) rosette formation, bridging necrosis in none and stage 1 fibrosis in one. Comparing NAEH with AIH, AIH showed significantly older age at presentation, female predisposition, past history of jaundice, lower ALT, more autoantibodies, higher IgG, higher grade interface hepatitis, lymphoplasmacytic infiltrate, rosette formation and higher bilirubin, AST at three months. NAEH and viral hepatitis had similar features.
Etiology of NAEH is unlikely to be autoimmune and is probably viral, unidentified as yet. Uncomplicated NAEH likely has self-limiting course even without specific treatment.
非酒精性肝炎（NAEH）不导致急性肝衰竭（ALF）的情况记录较少。本研究的目的是比较单纯性急性 NAEH 与急性病毒性（AVH）和自身免疫性肝炎（AIH）的临床和实验室特征，并比较 NAEH 和 AIH 的组织病理学特征。
纳入肝细胞性黄疸患者。根据临床、实验室检查结果，并在必要时进行肝活检，将这些患者分为 AVH、AIH 和 NAEH。对 NAEH 和 AIH 患者进行三个月的随访。
336 例肝细胞性黄疸患者中，15 例（5%）为 NAEH，25 例（7%）为急性 AIH，45 例（14%）为 AVH。在 NAEH 患者中，7 例（46.7%）为男性，发病时的平均年龄为 39 岁。黄疸（100%）是 NAEH 最常见的表现。胆红素峰值为 10.7mg/dL。天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）峰值分别为 512U/L 和 670U/L。5 例（33.3%）患者抗核抗体阳性，1 例抗平滑肌抗体阳性。平均免疫球蛋白 G（IgG）水平为 1829mg/dL。肝活检显示，所有患者均有气球样变性，4 例（26.7%）有轻度界面性肝炎，3 例（20%）有中度界面性肝炎，4 例（26.7%）有轻度淋巴浆细胞浸润，1 例（6.7%）有玫瑰花结形成，无桥接坏死，1 例有 1 期纤维化。与 AIH 相比，NAEH 患者的发病年龄更小，以男性为主，既往有黄疸史，ALT 较低，自身抗体更多，IgG 更高，界面性肝炎、淋巴浆细胞浸润、玫瑰花结形成程度更高，胆红素、AST 水平更高，但在三个月时均恢复正常。NAEH 和病毒性肝炎的特征相似。
NAEH 的病因可能不是自身免疫性的，而是尚未明确的病毒。即使不进行特异性治疗，单纯性 NAEH 也可能具有自限性病程。
