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. 2023 Nov 28:8:100220.
doi: 10.1016/j.jtauto.2023.100220. eCollection 2024 Jun.

Liver inflammation activity in patients with autoimmune hepatitis with normal alanine aminotransferase and immunoglobulin G levels

Yun Chen  1 , Jiacheng Liu  2 , Jian Wang  2   3 , Weihua Wu  2 , Huali Wang  4 , Yilin Liu  5 , Zhiyi Zhang  5 , Shaoqiu Zhang  2 , Yifan Pan  1 , Yiguang Li  6 , Weimao Ding  7 , Li Zhu  8 , Chuanwu Zhu  8 , Jie Li  1   2   3   5 , Yuanwang Qiu  6 , Rui Huang  1   2   3   5 , Chao Wu  1   2   3   5
Affiliations

Liver inflammation activity in patients with autoimmune hepatitis with normal alanine aminotransferase and immunoglobulin G levels

Yun Chen et al. J Transl Autoimmun. .

Abstract

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.

Keywords: Alanine aminotransferase; Autoimmune hepatitis; Immunoglobulin G; Liver inflammation.

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Conflict of interest statement

All authors have no disclosures.

Figures

Fig. 1
Fig. 1
Flow chart of patient selection.
Fig. 2
Fig. 2
Distribution of liver inflammation and fibrosis in patients with autoimmune hepatitis.
Fig. 3
Fig. 3
Liver inflammation and fibrosis of patients with AIH depending on ALT and IgG levels.
Fig. 4
Fig. 4
Receiver operating characteristic curve of different parameters for predicting advanced inflammation in patients with AIH.
See this image and copyright information in PMC

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References

    1. Tanaka A. Autoimmune hepatitis: 2019 update. Gut Liver. 2020;14:430–438. doi: 10.5009/gnl19261. - DOI - PMC - PubMed
    1. Wang G., Tanaka A., Zhao H., Jia J., Ma X., Harada K., Wang F.S., Wei L., Wang Q., Sun Y., Hong Y., Rao H., Efe C., Lau G., Payawal D., Gani R., Lindor K., Jafri W., Omata M., Sarin S.K. The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis. Hepatol Int. 2021;15:223–257. doi: 10.1007/s12072-021-10170-1. - DOI - PMC - PubMed
    1. Gatselis N.K., Zachou K., Koukoulis G.K., Dalekos G.N. Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics. World J. Gastroenterol. 2015;21:60–83. doi: 10.3748/wjg.v21.i1.60. - DOI - PMC - PubMed
    1. Roberts S.K., Therneau T.M., Czaja A.J. Prognosis of histological cirrhosis in type 1 autoimmune hepatitis. Gastroenterology. 1996;110:848–857. doi: 10.1053/gast.1996.v110.pm8608895. - DOI - PubMed
    1. Luth S., Herkel J., Kanzler S., Frenzel C., Galle P.R., Dienes H.P., Schramm C., Lohse A.W. Serologic markers compared with liver biopsy for monitoring disease activity in autoimmune hepatitis. J. Clin. Gastroenterol. 2008;42:926–930. doi: 10.1097/MCG.0b013e318154af74. - DOI - PubMed

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