The revised international autoimmune hepatitis score in chronic liver diseases including autoimmune hepatitis/overlap syndromes and autoimmune hepatitis with concurrent other liver disorders

Journal of Autoimmune Diseases - Tập 4 - Trang 1-12 - 2007
Panagiotis A Papamichalis1,2, Kalliopi Zachou1,2, George K Koukoulis3, Aikaterini Veloni2, Efthimia G Karacosta2, Lampros Kypri2, Ioannis Mamaloudis2, Stella Gabeta1, Eirini I Rigopoulou2, Ansgar W Lohse4, George N Dalekos1,2
1Dept of Medicine, Research Laboratory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
2Dept. of Medicine, Academic Liver Unit, Medical School, University of Thessaly, Larissa, Greece
3Dept. of Pathology, Medical School, University of Thessaly, Larissa, Greece
4Dept. of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Tóm tắt

We conducted a study in order to determine the usefulness and diagnostic value of International Autoimmune Hepatitis Group (IAHG) score in non-autoimmune hepatitis (AIH) hepatic disorders as well as in AIH/overlap syndromes and in cases with coexistence of AIH and other liver diseases. We applied the IAHG score in 423 patients with liver diseases excluding patients with AIH, AIH/overlap syndromes and AIH with concurrent other liver disease namely, patients with chronic hepatitis B (n = 109), chronic hepatitis C (n = 95), chronic hepatitis D (n = 4), alchoholic liver disease (n = 28), non-alcoholic fatty liver disease (n = 55), autoimmune cholestatic liver diseases (n = 77), liver disorders of undefined origin (n = 32) and with miscellaneous hepatic disorders (n = 23). 24 patients with AIH associated with any kind of liver disorder including 10 patients with AIH/overlap syndromes and 14 AIH with concurrent other liver disease were also investigated. 43 patients with AIH consisted the control group. The specificity of the score was 98.1% while the sensitivity in unmasking AIH in patients with either AIH/overlap syndromes or AIH with concurrent other liver diseases was only 50% and 78.6%. In the binary logistic regression model, the presence of other autoimmune diseases (p < 0.001), the total histological score (p < 0.001) and positivity for autoantibodies (p < 0.05) were identified as independent predictors for the presnce of AIH/ovea syndromes o AI with concurren other liver diseass. The IAHG scoring system has very good specificity for excluding AIH in patients with chronic liver diseases but not that sensitivity in order to unmask AIH/overlap syndromes or AIH with concurrent other liver diseases. The presence of other autoimmune diseases or autoantibody markers in the absence of hepatitis viral markers should alarm physicians for the possible presence of AIH either as "pure" AIH or in association with other liver disorders (AIH/overlap syndromes or AIH with concurrent other liver diseases). Under these conditions, liver histology seems essential and it must always be included in the work up of hepatic patients.

Tài liệu tham khảo

Manns MP, Vogel A: Autoimmune hepatitis, from mechanisms to therapy. Hepatology. 2006, 43 (2 Suppl 1): S132-S144. 10.1002/hep.21059. Krawitt EL: Autoimmune hepatitis. N Engl J Med. 2006, 354: 54-66. 10.1056/NEJMra050408. Czaja AJ: Autoimmune liver disease. Curr Opin Gastroenterol. 2006, 22: 234-240. 10.1097/01.mog.0000218959.48064.7f. Zachou K, Rigopoulou E, Dalekos GN: Autoantibodies and autoantigens in autoimmune hepatitis: important tools in clinical practice and to study pathogenesis of the disease. J Autoimmune Dis. 2004, 1 (1): 2-10.1186/1740-2557-1-2. Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, Chapman RW, Cooksley WG, Czaja AJ, Desmet VJ, Donaldson PT, Eddleston AL, Fainboim L, Heathcote J, Homberg JC, Hoofnagle JH, Kakumu S, Krawitt EL, Mackay IR, MacSween RN, Maddrey WC, Manns MP, McFarlane IG, Meyer zum Buschenfelde KH, Zeniya M: International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999, 31: 929-938. 10.1016/S0168-8278(99)80297-9. Yatsuji S, Hashimoto E, Kaneda H, Taniai M, Tokushige K, Shiratori K: Diagnosing autoimmune hepatitis in nonalcoholic fatty liver disease: is the International Autoimmune Hepatitis Group scoring system useful?. J Gastroenterol. 2005, 40: 1130-1138. 10.1007/s00535-005-1711-z. Adams LA, Lindor KD, Angulo P: The prevalence of autoantibodies and autoimmune hepatitis in patients with nonalcoholic fatty liver disease. Am J Gastroenterol. 2004, 99: 1316-1320. 10.1111/j.1572-0241.2004.30444.x. Czaja AJ, Carpenter HA: Histological findings in chronic hepatitis C with autoimmune features. Hepatology. 1997, 26: 459-466. 10.1002/hep.510260229. Liaskos C, Rigopoulou E, Zachou K, Georgiadou S, Gatselis N, Papamihali R, Dalekos GN: Prevalence and clinical significance of anticardiolipin antibodies in patients with type 1 autoimmune hepatitis. J Autoimmun. 2005, 24: 251-260. 10.1016/j.jaut.2005.01.016. Johnson PJ, McFarlane IG: Meeting report: International Autoimmune Hepatitis Group. Hepatology. 1993, 18: 998-1005. 10.1002/hep.1840180435. Dalekos GN, Achenbach K, Christodoulou D, Liapi GK, Zervou EK, Sideris DA, Tsianos EV: Idiopathic dilated cardiomyopathy: lack of association with hepatitis C virus infection. Heart. 1998, 80: 270-275. Zachou K, Liaskos C, Christodoulou DK, Kasdasi M, Papadamou G, Gatselis N, Tsianos EV, Dalekos GN: Anti-cardiolipin antibodies in patients with chronic viral hepatitis are independent of beta2-glycoprotein I cofactor or features of antiphospholipid syndrome. Eur J Clin Invest. 2003, 33: 161-168. 10.1046/j.1365-2362.2003.01110.x. Satra M, Dalekos GN, Kollia P, Vamvakopoulos N, Tsezou A: Telomerase reverse transcriptase mRNA expression in peripheral lymphocytes of patients with chronic HBV and HCV infections. J Viral Hepat. 2005, 12: 488-493. 10.1111/j.1365-2893.2005.00550.x. Dalekos GN, Christodoulou D, Kistis KG, Zervou EK, Hatzis J, Tsianos EV: A prospective evaluation of dermatologic side effects during alpha-interferon therapy for chronic viral hepatitis. Eur J Gastroenterol Hepatol. 1998, 10: 933-939. Christodoulou DK, Dalekos GN, Merkouropoulos MH, Kistis KG, Georgitsi G, Zervou E, Tsianos EV: Cryoglobulinemia due to chronic viral hepatitis infections is not a major problem in clinical practice. Eur J Intern Med. 2001, 12: 435-441. 10.1016/S0953-6205(01)00151-0. Dalekos GN, Galanakis E, Zervou E, Tzoufi M, Lapatsanis PD, Tsianos EV: Interferon-alpha treatment of children with chronic hepatitis D virus infection : the Greek experience. Hepatogastroenterology. 2000, 47: 1072-1076. The EASL jury: EASL International Consensus Conference on Hepatitis B, 13–14 September, 2002, Geneva, Switzerland. Consensus statement (Short version). J Hepatol. 2003, 38: 533-540. Kyriakou DS, Alexandrakis MG, Zachou K, Passam F, Stathakis NE, Dalekos GN: Hemopoietic progenitor cells and bone marrow stromal cells in patients with autoimmune hepatitis type 1 and primary biliary cirrhosis. J Hepatol. 2003, 39: 679-685. 10.1016/S0168-8278(03)00387-8. Tsikrikoni A, Kyriakou DS, Rigopoulou E, Alexandrakis MG, Zachou K, Passam F, Dalekos GN: Markers of cell activation and apoptosis in bone marrow mononuclear cells of patients with autoimmune hepatitis type 1 and primary biliary cirrhosis. J Hepatol. 2005, 42: 393-399. 10.1016/j.jhep.2004.11.023. Zachou K, Liaskos C, Rigopoulou E, Gabeta S, Papamichalis P, Gatselis N, Georgiadou S, Dalekos GN: Presence of high avidity anticardiolipin antibodies in patients with autoimmune cholestatic liver diseases. Clin Immunol. 2006, 119: 203-212. 10.1016/j.clim.2006.01.002. Poupon R, Chazouilleres O, Poupon RE: Chronic cholestatic diseases. J Hepatol. 2000, 32: 129-140. 10.1016/S0168-8278(00)80421-3. Manns M, Gerken G, Kyriatsoulis A, Trautwein C, Reske K, Meyer zum Büschenfelde K-H: Two different subtypes of antimitochondrial antibodies are associated with primary biliary cirrhosis: identification and characterization by radioimmunoassay and immunoblotting. Hepatology. 1987, 5: 893-899. 10.1002/hep.1840070517. Neuschwander-Tetri BA, Caldwell SH: Nonalcoholic steatohepatitis: summary of an AASLD Single Topic Conference. Hepatology. 2003, 37: 1202-1219. 10.1053/jhep.2003.50193. Chazouilleres O: Diagnosis of primary sclerosing cholangitis – autoimmune hepatitis overlap syndrome: to score or not to score?. J Hepatol. 2000, 33: 661-663. 10.1034/j.1600-0641.2000.033004661.x. Beuers U: Hepatic overlap syndromes. J Hepatol. 2005, 42: S93-S99. 10.1016/j.jhep.2004.11.009. Chazouilleres O, Wendum D, Serfaty L, Montembault S, Rosmorduc O, Poupon R: Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome : clinical features and response to therapy. Hepatology. 1998, 28: 296-301. 10.1002/hep.510280203. Dalekos GN, Makri E, Loges S, Obermayer-Straub P, Zachou K, Tsikrikas T, Schmidt E, Papadamou G, Manns MP: Increased incidence of anti-LKM autoantibodies in a consecutive cohort of hepatitis C patients from central Greece. Eur J Gastroenterol Hepatol. 2002, 14: 35-42. 10.1097/00042737-200201000-00007. Dalekos GN, Wedemeyer H, Obermayer-Straub P, Kayser A, Barut A, Frank H, Manns MP: Epitope mapping of cytochrome P4502D6 autoantigen in patients with chronic hepatitis C during alpha-interferon treatment. J Hepatol. 1999, 30: 366-375. 10.1016/S0168-8278(99)80092-0. Vergani D, Alvarez F, Bianchi FB, Cancado EL, Mackay IR, Manns MP, Nishioka M, Penner E: Liver autoimmune serology: a consensus statement from the committee for autoimmune serology of the International Autoimmune Hepatitis Group. J Hepatol. 2004, 41: 677-683. 10.1016/j.jhep.2004.08.002. Dalekos GN, Zachou K, Liaskos C, Gatselis N: Autoantibodies and defined target autoantigens in autoimmune hepatitis: an overview. Eur J Intern Med. 2002, 13: 293-303. 10.1016/S0953-6205(02)00089-4. Gatselis NK, Georgiadou SP, Tassopoulos N, Zachou K, Liaskos C, Hatzakis A, Dalekos GN: Impact of parietal cell autoantibodies and non-organ-specific autoantibodies on the treatment outcome of patients with hepatitis C virus infection: A pilot study. World J Gastroenterol. 2005, 11: 482-487. Farias AQ, Goncalves LL, Bittencourt PL, De Melo ES, Abrantes-Lemos CP, Porta G, Nakhle MC, Carrilho FJ, Cancado EL: Applicability of the IAIHG scoring system to the diagnosis of antimitochondrial/anti-M2 seropositive variant form of autoimmune hepatitis. J Gastroenterol Hepatol. 2006, 21: 887-893. 10.1111/j.1440-1746.2006.04130.x. Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos G, Krawitt E, Bittencourt PL, Boberg KM, Hofer H, Bianchi FB, Victor A, Dienes HP, de Torres BE, Galle PR, Lohse AW: Simplified diagnostic criteria for autoimmune hepatitis. Hepatology. 2005, 42: 295A- Cassani F, Cataleta M, Valentini P, Muratori P, Giostra F, Francesconi R, Muratori L, Lenzi M, Bianchi G, Zauli D, Bianchi FB: Serum autoantibodies in chronic hepatitis C: comparison with autoimmune hepatitis and impact on the disease profile. Hepatology. 1997, 26: 561-566. 10.1002/hep.510260305. Lenzi M, Bellentani S, Saccoccio G, Muratori P, Masutti F, Muratori L, Cassani F, Bianchi FB, Tiribelli C: Prevalence of non-organ-specific autoantibodies and chronic liver disease in the general population: a nested case-control study of the Dionysos cohort. Gut. 1999, 45: 435-441. Dalekos GN, Manoussakis MN, Zervou E, Tsianos EV, Moutsopoulos HM: Immunologic and viral markers in the circulation of anti-HIV negative heroin addicts. Eur J Clin Invest. 1993, 23: 219-225. Muratori P, Muratori L, Guidi M, Granito A, Susca M, Lenzi M, Bianchi FB: Clinical impact of non-organ-specific autoantibodies on the response to combined antiviral treatment in patients with hepatitis C. Clin Infect Dis. 2005, 40: 501-507. 10.1086/427285. Cotler SJ, Kanji K, Keshavarzian A, Jensen DM, Jakate S: Prevalence and significance of autoantibodies in patients with non-alcoholic steatohepatitis. J Clin Gastroenterol. 2004, 38: 801-804. 10.1097/01.mcg.0000139072.38580.a0. Loria P, Lonardo A, Leonardi F, Fontana C, Carulli L, Verrone AM, Borsatti A, Bertolotti M, Cassani F, Bagni A, Muratori P, Ganazzi D, Bianchi FB, Carulli N: Non-organ-specific autoantibodies in nonalcoholic fatty liver disease: prevalence and correlates. Dig Dis Sci. 2003, 48: 2173-2181. 10.1023/B:DDAS.0000004522.36120.08. Lytton SD, Helander A, Zhang-Gouillon ZQ, Stokkeland K, Bordone R, Arico S, Albano E, French SW, Ingelman-Sundberg M: Autoantibodies against cytochromes P-4502E1 and P-4503A in alcoholics. Mol Pharmacol. 1999, 55: 223-233. Ma Y, Meregalli M, Hodges S, Davies N, Bogdanos DP, Fargion S, Fiorelli G, Vergani D: Alcohol dehydrogenase: an autoantibody target in patients with alcoholic liver disease. Int J Immunopathol Pharmacol. 2005, 18: 173-182. Dickson RC, Gaffey MJ, Ishitani MB, Roarty TP, Driscoll CJ, Caldwell SH: The international autoimmune hepatitis score in chronic hepatitis C. J Viral Hepat. 1997, 4: 121-128. van Buuren HR, van Hoogstraten HJE, Terkivatan T, Schalm SW, Vleggaar FP: High prevalence of autoimmune hepatitis among patients with primary sclerosing cholangitis. J Hepatol. 2000, 33: 543-548. 10.1034/j.1600-0641.2000.033004543.x. Talwalkar JA, Keach JC, Angulo P, Lindor KD: Overlap of autoimmune hepatitis and primary biliary cirrhosis: an evaluation of a modified scoring system. Am J Gastroenterol. 2002, 97: 1191-1197. 10.1111/j.1572-0241.2002.05703.x. Czaja AJ: Frequency and nature of the variant syndromes of autoimmune liver disease. Hepatology. 1998, 28: 360-365. 10.1002/hep.510280210. Kaya M, Angulo P, Lindor KD: Overlap of autoimmune hepatitis and primary sclerosing cholangitis: an evaluation of a modified scoring system. J Hepatol. 2000, 33: 537-542. 10.1034/j.1600-0641.2000.033004537.x. Boberg KM, Fausa O, Haaland T, Holter E, Mellbye OJ, Spurkland A, Schrumpf E: Features of autoimmune hepatitis in primary sclerosing cholangitis: an evaluation of 114 primary sclerosing cholangitis patients according to a scoring system for the diagnosis of autoimmune hepatitis. Hepatology. 1996, 23: 1369-1376. 10.1002/hep.510230612. Ben-Ari Z, Czaja AJ: Autoimmune hepatitis and its variant syndromes. Gut. 2001, 49: 589-594. 10.1136/gut.49.4.589.
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Journal of Autoimmune Diseases

Tập 4

1-12

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