[Clinical characteristics of a utoimmune hepatitis]

ABSTRACT

Autoimmune hepatitis [AIM] is a self-perpetuating hepatocellular inflammation of unknown cause. It is characterized by the presence of interface hepatitis on histologic examination, hyper gammaglobulinemia, and autoantibodies in serum. This study was performed to determine clinical and laboratory profile of AIH in Iran. The medical records of patients with AIM from 4 gastroenterology clinics in Tehran were retrospectively reviewed from September 1988 to May 2003. Forty-six patients with AIM whose medical records were complete were selected for final review. Of the 46 patients, 38 [82%] were female. The median age at presentation was 24 years. All patients fell into the category of AIM type-I. Seventeen percent had associated autoimmune diseases with diabetes type-I and autoimmune hemolytic disease being more common. The onset was acute in 5% and chronic in 87% with the remaining 8% being asymptomatic. The most common symptoms were icterus [59%] and fatigue [33%] and the most common signs were splenomegaly [33%] and hepatomegaly [30%]. In all cases, HBV and HCV serum markers were negative and serum levels of ferritin and copper were within normal limits. High serum levels of AST, total billirubin and alkaline phosphatase were detected in 93%, 39% and 74%, respectively while hyper gammaglobulinemia was found in 67%. SMA, ANA, PANCA and A MA were positive in 50%, 37%, 4% and 13%, respectively. AIH type-I is more common in Iran than in the United States and Europe and other types are seen rarely. Younger age at presentation, less frequent acute onset disease and lower rate of autoantibody positivity and hyper gammaglobulinemia may merit attention