Autoimmune hepatitis in the material of Clinic and Regional Hospital of Infectious Diseases in Gdańsk
Zofia Michalska, Danuta Radowska, Piotr Stalke, Katarzyna Sikorska, Anna Lakomy, Krystyna Witczak-Malinowska, Alicja Bąkowska, Julian Stolarczyk, Hanna Trocha, Agnieszka Pawlak, Maciej Kowalik
Med Sci Monit 2003; 9(3): 49-54
Background: The aim of the study was the analysis of patients with autoimmune hepatitis (AIH), with respect to diagnostics, clinical course and treatment, based on the material from the wards of infectious diseases.
Material/Methods: The study was carried out in the material of 106 AIH patients – 95 females aged 11-81 (mean age 46 years) and 11 males aged 8-73 (mean age 35 years).The diagnosis of AIH was based on international criteria, including biochemical investigations, autoantibodies, and liver tissue morphology. Serological investigations excluded hepatitis of viral etiology. Diagnostic procedures included also blood cell count, biochemical parameters of liver function with protein fractions, immunoassays (imunoglobulins, autoantibodies), according to commonly used methods. Liver biopsies were performed in 93 patients.Results: The clinical presentation mimicked acute viral hepatitis in 75% of cases, in the remaining 25% corresponded to chronic viral hepatitis. 26% had other coincident disorders of autoimmune etiology In 84% the initial stage of the disease was characterized with moderately severe course, in 11% - severe, 7% of the patients died – half of them at the initial stage of the disease. The following morphological patterns of hepatic abnormalities were observed: hepatitis chronica agresiva, fibrosis periportalis, hepatitis chronica agresiva in cirrhosim vertens, cirrhosis hepatis activa, hepatitis chronica persistens, hepatitis granulomatosa. Over 40% of patients demonstrated relapses of the disease due to discontinuation of treatment after obtaining clinical and biochemical remission. 51 patients were treated with glucocorticosteroid monotherapy, the same number with glucocorticosteroids combined with azathioprine, 1 female patient underwent liver transplantation. In nearly 30% of patients, the diagnosis of AIH was established after a period of persistence of pathologic symptoms of over a year. Conclusions: Late diagnoses of AIH indicate insufficient knowledge of the disease among physicians. The methods of treatment used in AIH are not sufficiently effective. Discontinuation of treatment should be preceded in each case by overall assessment of the pathologic process, including biochemical parameters, autoantibody level and liver histopathology.
Keywords: autoimmune hepatitis, Autoantibodies, Liver biopsy