Tatour Mifleh, Baker Fadi Abu, Saadi Tarek, Yahia Ahmad, Hazzan Rawi
Clalit Health Services, Nof Hagalil, Israel; Department of Family Medicine, Clalit Health Services, Afula, Israel.
Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera 38100, Israel; Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel.
Clin Res Hepatol Gastroenterol. 2025 Apr;49(4):102570. doi: 10.1016/j.clinre.2025.102570. Epub 2025 Mar 4.
Autoimmune hepatitis (AIH) is a rare, heterogeneous liver disease marked by autoantibodies, hypergammaglobulinemia, and distinct histological features. Predominantly affecting women, its incidence and prevalence show significant regional variability globally. Therefore, our aim is to examine the trends of AIH and to assess its demographics, management, and disease progression using an extensive population-based database.
This retrospective, population-based study analyzed data from 2.7 million adults in Clalit Health Services, focusing on autoimmune hepatitis (AIH) diagnoses between 2009 and 2023. Data reordered included demographics, clinical details, and treatment regimens. Key outcomes tracked were the development of cirrhosis and its complications.
This study included 992 AIH patients with a median age of 51.5 years, 80.4 % female, and a median follow-up of 6.1 years. Obesity was present in 23.2 %, and 10.9 % had thyroid disease. At diagnosis, 22.9 % had cirrhosis, and an additional 137 patients developed cirrhosis during follow-up, leading to a total prevalence of 36.5 %. Among cirrhotic patients, 29.9 % experienced decompensation, 25.3 % developed ascites, 9.3 % had variceal bleeding, and 10.4 % developed hepatic encephalopathy. Hepatocellular carcinoma (HCC) occurred in 5.24 % of cirrhotic patients, with an incidence rate of 6.32 cases per 1000 patient-years. Overall, 11.2 % of cirrhotic patients underwent liver transplantation. The proportion of AIH patients diagnosed with cirrhosis at the time of diagnosis significantly decreased over the study period (p = 0.0028).
This study demonstrates a decreasing trend in AIH patients diagnosed with cirrhosis, suggesting earlier detection and improved management, alongside a lower documented incidence of HCC.
自身免疫性肝炎（AIH）是一种罕见的异质性肝脏疾病，其特征为自身抗体、高球蛋白血症以及独特的组织学特征。该疾病主要影响女性，在全球范围内其发病率和患病率存在显著的地区差异。因此，我们的目的是利用一个广泛的基于人群的数据库来研究AIH的发展趋势，并评估其人口统计学特征、治疗情况和疾病进展。
这项基于人群的回顾性研究分析了克拉利特健康服务中心270万成年人的数据，重点关注2009年至2023年间自身免疫性肝炎（AIH）的诊断情况。整理的数据包括人口统计学特征、临床细节和治疗方案。追踪的主要结局是肝硬化及其并发症的发生情况。
本研究纳入了992例AIH患者，中位年龄为51.5岁，女性占80.4%，中位随访时间为6.1年。23.2%的患者存在肥胖，10.9%的患者患有甲状腺疾病。诊断时，22.9%的患者已出现肝硬化，另有137例患者在随访期间发展为肝硬化，总体患病率为36.5%。在肝硬化患者中，29.9%出现失代偿，25.3%出现腹水，9.3%发生静脉曲张出血，10.4%发生肝性脑病。肝细胞癌（HCC）在5.24%的肝硬化患者中发生，发病率为每1000患者年6.32例。总体而言，11.2%的肝硬化患者接受了肝移植。在研究期间，诊断时即被诊断为肝硬化的AIH患者比例显著下降（p = 0.0028）。
本研究表明，被诊断为肝硬化的AIH患者呈下降趋势，这表明检测更早、管理得到改善，同时记录的HCC发病率较低。
