Yun Chen , Jiacheng Liu , Jian Wang , Weihua Wu , Huali Wang , Yilin Liu , Zhiyi Zhang , Shaoqiu Zhang , Yifan Pan , Yiguang Li , Weimao Ding , Li Zhu , Chuanwu Zhu , Jie Li , Yuanwang Qiu , Rui Huang , Chao Wu
{"title":"丙氨酸氨基转移酶和免疫球蛋白 G 水平正常的自身免疫性肝炎患者的肝脏炎症活性","authors":"Yun Chen , Jiacheng Liu , Jian Wang , Weihua Wu , Huali Wang , Yilin Liu , Zhiyi Zhang , Shaoqiu Zhang , Yifan Pan , Yiguang Li , Weimao Ding , Li Zhu , Chuanwu Zhu , Jie Li , Yuanwang Qiu , Rui Huang , Chao Wu","doi":"10.1016/j.jtauto.2023.100220","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and aims</h3><p>Normal serum transaminases and immunoglobulin G (IgG) levels are surrogate markers for hepatic histologic disease activity in autoimmune hepatitis (AIH). This study aimed to evaluate liver inflammation in patients with AIH with normal serum alanine aminotransferase (ALT) and IgG levels.</p></div><div><h3>Methods</h3><p>Two hundred and five AIH patients who underwent liver biopsy in four medical centers were included. Logistic regression analysis was used to identify risk factors associated with advanced inflammation.</p></div><div><h3>Results</h3><p>One hundred and thirty-one (63.9 %) AIH patients had advanced liver inflammation, and 108 (52.7 %) patients had advanced liver fibrosis. 60.0 % of patients with normal ALT and 51.7 % of patients with normal ALT and IgG had advanced inflammation. However, 76.7 % and 35.0 % of patients with or without advanced fibrosis with normal ALT had advanced inflammation, while the corresponding proportions of advanced inflammation were 78.6 % and 26.7 % in patients with normal ALT and IgG, respectively. Moreover, 81.0 % and 44.8 % of patients with and without cirrhosis with normal ALT had advanced inflammation, while the corresponding proportions were 83.3 % and 29.4 % in patients with normal ALT and IgG, respectively. Red cell distribution width (OR = 1.325, 95%CI 1.045–1.681, P = 0.020) and PT (OR = 1.514, 95%CI 1.138–2.014, P = 0.004) were independent factors associated with advanced inflammation.</p></div><div><h3>Conclusions</h3><p>High proportion of advanced inflammation was found in AIH patients with normal ALT and IgG levels despite without advanced fibrosis. Although using non-invasive methods may contribute to rule out liver fibrosis in AIH patients with normal ALT and IgG levels, liver biopsy is encouraged to assess liver inflammation.</p></div>","PeriodicalId":36425,"journal":{"name":"Journal of Translational Autoimmunity","volume":null,"pages":null},"PeriodicalIF":4.7000,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589909023000333/pdfft?md5=24ecc364b25e78fc6e1dc44a40b337eb&pid=1-s2.0-S2589909023000333-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Liver inflammation activity in patients with autoimmune hepatitis with normal alanine aminotransferase and immunoglobulin G levels\",\"authors\":\"Yun Chen , Jiacheng Liu , Jian Wang , Weihua Wu , Huali Wang , Yilin Liu , Zhiyi Zhang , Shaoqiu Zhang , Yifan Pan , Yiguang Li , Weimao Ding , Li Zhu , Chuanwu Zhu , Jie Li , Yuanwang Qiu , Rui Huang , Chao Wu\",\"doi\":\"10.1016/j.jtauto.2023.100220\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and aims</h3><p>Normal serum transaminases and immunoglobulin G (IgG) levels are surrogate markers for hepatic histologic disease activity in autoimmune hepatitis (AIH). This study aimed to evaluate liver inflammation in patients with AIH with normal serum alanine aminotransferase (ALT) and IgG levels.</p></div><div><h3>Methods</h3><p>Two hundred and five AIH patients who underwent liver biopsy in four medical centers were included. Logistic regression analysis was used to identify risk factors associated with advanced inflammation.</p></div><div><h3>Results</h3><p>One hundred and thirty-one (63.9 %) AIH patients had advanced liver inflammation, and 108 (52.7 %) patients had advanced liver fibrosis. 60.0 % of patients with normal ALT and 51.7 % of patients with normal ALT and IgG had advanced inflammation. However, 76.7 % and 35.0 % of patients with or without advanced fibrosis with normal ALT had advanced inflammation, while the corresponding proportions of advanced inflammation were 78.6 % and 26.7 % in patients with normal ALT and IgG, respectively. Moreover, 81.0 % and 44.8 % of patients with and without cirrhosis with normal ALT had advanced inflammation, while the corresponding proportions were 83.3 % and 29.4 % in patients with normal ALT and IgG, respectively. Red cell distribution width (OR = 1.325, 95%CI 1.045–1.681, P = 0.020) and PT (OR = 1.514, 95%CI 1.138–2.014, P = 0.004) were independent factors associated with advanced inflammation.</p></div><div><h3>Conclusions</h3><p>High proportion of advanced inflammation was found in AIH patients with normal ALT and IgG levels despite without advanced fibrosis. Although using non-invasive methods may contribute to rule out liver fibrosis in AIH patients with normal ALT and IgG levels, liver biopsy is encouraged to assess liver inflammation.</p></div>\",\"PeriodicalId\":36425,\"journal\":{\"name\":\"Journal of Translational Autoimmunity\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2023-11-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2589909023000333/pdfft?md5=24ecc364b25e78fc6e1dc44a40b337eb&pid=1-s2.0-S2589909023000333-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Translational Autoimmunity\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589909023000333\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Translational Autoimmunity","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589909023000333","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的血清转氨酶和免疫球蛋白 G (IgG) 水平正常是自身免疫性肝炎(AIH)肝组织学疾病活动性的替代标记物。本研究旨在评估血清丙氨酸氨基转移酶(ALT)和 IgG 水平正常的 AIH 患者的肝脏炎症情况。结果 131 例(63.9%)AIH 患者有晚期肝脏炎症,108 例(52.7%)患者有晚期肝纤维化。60.0%的谷丙转氨酶(ALT)正常患者和51.7%的谷丙转氨酶(ALT)和IgG正常患者患有晚期炎症。然而,在有或没有晚期肝纤维化且 ALT 正常的患者中,76.7% 和 35.0% 有晚期炎症,而在 ALT 和 IgG 正常的患者中,相应的晚期炎症比例分别为 78.6% 和 26.7%。此外,在 ALT 正常的肝硬化患者和非肝硬化患者中,分别有 81.0% 和 44.8% 的人炎症晚期,而在 ALT 和 IgG 正常的患者中,相应比例分别为 83.3% 和 29.4%。红细胞分布宽度(OR = 1.325,95%CI 1.045-1.681,P = 0.020)和 PT(OR = 1.514,95%CI 1.138-2.014,P = 0.004)是与晚期炎症相关的独立因素。尽管使用非侵入性方法有助于排除ALT和IgG水平正常的AIH患者的肝纤维化,但仍鼓励进行肝活检以评估肝脏炎症。
Liver inflammation activity in patients with autoimmune hepatitis with normal alanine aminotransferase and immunoglobulin G levels
Background and aims
Normal serum transaminases and immunoglobulin G (IgG) levels are surrogate markers for hepatic histologic disease activity in autoimmune hepatitis (AIH). This study aimed to evaluate liver inflammation in patients with AIH with normal serum alanine aminotransferase (ALT) and IgG levels.
Methods
Two hundred and five AIH patients who underwent liver biopsy in four medical centers were included. Logistic regression analysis was used to identify risk factors associated with advanced inflammation.
Results
One hundred and thirty-one (63.9 %) AIH patients had advanced liver inflammation, and 108 (52.7 %) patients had advanced liver fibrosis. 60.0 % of patients with normal ALT and 51.7 % of patients with normal ALT and IgG had advanced inflammation. However, 76.7 % and 35.0 % of patients with or without advanced fibrosis with normal ALT had advanced inflammation, while the corresponding proportions of advanced inflammation were 78.6 % and 26.7 % in patients with normal ALT and IgG, respectively. Moreover, 81.0 % and 44.8 % of patients with and without cirrhosis with normal ALT had advanced inflammation, while the corresponding proportions were 83.3 % and 29.4 % in patients with normal ALT and IgG, respectively. Red cell distribution width (OR = 1.325, 95%CI 1.045–1.681, P = 0.020) and PT (OR = 1.514, 95%CI 1.138–2.014, P = 0.004) were independent factors associated with advanced inflammation.
Conclusions
High proportion of advanced inflammation was found in AIH patients with normal ALT and IgG levels despite without advanced fibrosis. Although using non-invasive methods may contribute to rule out liver fibrosis in AIH patients with normal ALT and IgG levels, liver biopsy is encouraged to assess liver inflammation.