背景:这项横断面研究旨在研究代谢相关疾病(MAD)对自身免疫性肝炎(AIH)患者的影响。
方法:分析2016年1月至2022年2月在瑞金医院行肝脏活检的283例AIH患者的临床特点。上海,中国。
结果:在确定的AIH患者中(n=283),87.3%,23.0%,或43.1%有MAD,非酒精性脂肪性肝病(NAFLD),或严重的纤维化,分别。在AIH队列中,重度肝纤维化患者的糖尿病(DM)比例明显高于轻度或中度纤维化患者(31.1%vs.18.0%,p<0.05)。NAFLD患者的纤维化也比无NAFLD患者更严重(53.8%vs.39.9%,p<0.05)。年龄,Plts,IgG和MAD的存在被鉴定为AIH患者炎症严重程度的独立预测因子。此外,严重肝纤维化(3至4期)与男性(OR,2.855;p=0.025),γ-GT(OR,0.997;p=0.007),并与MAD(或,4.917;p=0.006)。此外,合并DM也是AIH患者严重肝纤维化的独立预测因子(OR,2.445,p=0.038)。
结论:并发MAD,常见于AIH患者,是严重纤维化或炎症的独立危险因素;值得注意的是,合并DM也是AIH患者严重肝纤维化的独立预测因子.在AIH管理时,共存MAD的常规评估,尤其是DM,也很重要。
BACKGROUND: This cross-sectional study aimed to investigate the impact of metabolic-associated diseases (MADs) on patients with autoimmune hepatitis (AIH).
METHODS: The study analyzed the clinical characteristics of 283 AIH patients who underwent liver biopsy between January 2016 and February 2022 in Ruijin Hospital, Shanghai, China.
RESULTS: Among the identified AIH patients (n = 283), 87.3%, 23.0%, or 43.1% had MADs, non-alcoholic fatty liver disease (NAFLD), or severe fibrosis, respectively. The proportion of diabetes mellitus (DM) was significantly higher in patients with severe liver fibrosis than in those with mild or moderate fibrosis in the AIH cohort (31.1% vs. 18.0%, p < 0.05). Fibrosis was also more severe in patients with NAFLD than in those without (53.8% vs. 39.9%, p < 0.05). Age, Plts, IgG and the presence with MADs were identified as independent predictors of the severity of inflammation in AIH patients. Moreover, severe liver fibrosis (stages 3 to 4) was independently associated with male (OR, 2.855; p = 0.025), γ-GT (OR, 0.997; p = 0.007), and combination with MADs (OR, 4.917; p = 0.006). Furthermore, combination with DM was also an independent predictor of severe liver fibrosis in AIH patients (OR, 2.445, p = 0.038).
CONCLUSIONS: Concurrent MADs, common in AIH patients, is an independent risk factor for severe fibrosis or inflammation; of note, combination with DM was also an independent predictor of severe liver fibrosis in AIH patients. While managing with AIH, routine assessment of co-existing MADs, especially DM, is also important.