Analysis of biochemical and pathological features as well as therapeutic response of autoimmune hepatitis in the elderly-onset patients / 中华消化杂志

ABSTRACT

Objective To investigate the differences in the biochemical and pathological features and therapeutic response between the elderly-onset autoimmune hepatitis (AIH) and young-onset AIH.Methods From October 2013 to November 2016,a total of 87 consecutive AIH patients diagnosed by liver biopsy were enrolled and divided into elderly-onset group (≥60 years) and the young-onset group (＜ 60 years).The biochemical and pathological features and therapeutic response of the two groups were compared.Mann Whitney test and chi square test were performed for statistical analysis.Results As AIH diagnosed,the proportion of liver cirrhosis detected by imaging examination of elderly-onset group and the young-onset group were 67.7％(21/31) and 35.7％(20/56),respectively,the former was higher than the latter,and the difference was statistically significant (X2 =8.214,P=0.004).The proportion of patients complicated with extrahepatic autoimmune diseases of the elderly-onset group was 9.7％ (3/31),which was lower than that of the young-onset group (28.6％,16/56),and the difference was statistically significant (X2 =4.173,P=0.041).The median levels of alanine aminotransferase (ALT) and albumin of the elderly-onset group were 50.0 U/L (22.0 U/L,193.0 U/L) and 34.8 g/L (31.3 g/L,40.5 g/L),which were lower than those of the young-onset group (146.0 U/L (43.8 U/L,390.5 U/L),39.4 g/L (35.8 g/L,44.6 g/L),and the differences were statistically significant (Z=-2.109,-2.092;both P＜ 0.05).Between the two groups,there was no statistically significant difference in inflammation grade,fibrosis stage,interface hepatitis,lymphoplasmacytic infiltration,positive rate of hepatocyte rosette pattern,positive rate of centrilobular necrosis and small bile duct injury (all P＞0.05).After treatment,among 17 patients of elderly-onset group,seven patients obtained biochemical remission and the median time to remission was 3.2 months;among 37 patients of young-onset group,18 patients (48.6％) obtained biochemical remission and the median time to remission was 2.3 months.There was no significant difference in the percentage of patients achieved biochemical remission and the median time between the two groups (both P＞0.05).Conclusion The percentage of complicated with extrahepatic autoimmune diseases of elderly-onset group is lower than that of young-onset group,which indicates that age-associated immune dysfunction may involve in the genesis and development of elderly-onset AIH.