Characteristics and Factors Associated with Inflammatory Activity on Liver Biopsy in Autoimmune Hepatitis Patients Aged 50 Years or Older
DOI:
https://doi.org/10.22516/25007440.1022Palavras-chave:
Autoimmune hepatitis, inflammation, γ-glutamyl transferase, AgingResumo
Introduction: Autoimmune hepatitis is an inflammatory liver disorder histologically characterized by portal lymphoplasmocytic hepatitis with interface activity and lobular inflammation.
Aims: To identify clinical characteristics associated with older age and also to pinpoint clinical characteristics associated with significant inflammation in liver histology.
Methods: Cross-sectional analytical study that evaluated medical records of adult patients with autoimmune hepatitis seen at the Gastroenterology and Hepatology Outward of a Tertiary University Hospital. Bivariate analysis was performed to identify the characteristics associated with age equal or greater than 50 years and the significant histological inflammatory activity.
Results: Forty-seven patients were included, with their mean age of 42.8±16.0 (43.0) years. Furthermore, 80.9% of them were women, 31.9% were 50 years-old or older. Thirty-one patients were submitted to liver biopsy and 29.0% presented significant inflammation. When compared in terms of age, individuals equal or higher 50 years old presented higher medians of GGT (129 vs. 282 U/L; P = 0.034) and a higher proportion of significant inflammation (50 vs. 6.7%; P = 0,024). Patients with significant inflammation on the liver biopsy presented a higher mean age (63.7±14.0 vs. 41.0±14.4; P = 0.001), and a greater proportion of patients equal or above 50 years old (85.7% vs. 66.7%; P=0.024) than individuals with mild inflammation.
Conclusions: Individuals equal or higher 50 years old presented higher medians of GGT levels and a greater proportion of significant inflammation on liver histology.
Downloads
Referências
Gronbaek L, Vilstrup H, Jepsen P. Autoimmune hepatitis in Denmark: incidence, prevalence, prognosis, and causes of death. A nationwide registry-based cohort study. J Hepatol. 2014;60(3):612-17. https://doi.org/10.1016/j.jhep.2013.10.020
Vergani D, Alvarez F, Bianchi F, Cançado EL, Mackay IR, Manns MP, et al. Liver autoimmune serology: a consensus statement from the committee for autoimmune serology of the International Autoimmune Hepatitis Group. J Hepatol. 2004;41(4):677-83. https://doi.org/10.1016/j.jhep.2004.08.002
Woreta TA, Alqahtani SA. Evaluation of abnormal liver tests. Med Clin North Am. 2014;98(1):1-16. https://doi.org/10.1016/j.mcna.2013.09.005
Czaja AJ. Natural history, clinical features, and treatment of autoimmune hepatitis. Semin Liver Dis. 1984;4(1):1-12. https://doi.org/10.1055/s-2008-1040641
Manns MP, Czaja AJ, Gorham JD, et al. Practice guidelines of the American Association for the Study of Liver Diseases. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51(6):2193-213. https://doi.org/10.1002/hep.23584
Abe M, Onji M, Kawai-Ninomiya K, Krawitt EL, Mieli-Vergani G, Vergani D, et al. Clinicopathologic Features of the Severe Form of Acute Type 1 Autoimmune Hepatitis. Clin Gastroenterol Hepatol. 2007;5(6):255-8. https://doi.org/10.1016/j.cgh.2006.10.011
Friedman SL. Molecular regulation of hepatic fibrosis, an integrated cellular response to tissue injury. J Biol Chem. 2000;275(4):2247-50. https://doi.org/10.1074/jbc.275.4.2247
Alvarez F, Berg PA, Bianchi FB, Bianchi L, Burroughs AK, Cancado EL, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatology. 1999;31(5):929-38. https://doi.org/10.1016/S0168-8278(99)80297-9
Gayotto LC. Visão histórica e consenso nacional sobre a classificação das hepatites crônicas: projeto do clube de patologia hepática da sociedade brasileira de patologia aprovado pela sociedade brasileira de hepatologia. GED Gastroenterol Endosc Dig 2000;19(3):137-40.
Pratt DS, Kaplan MM. Evaluation of abnormal liver-enzyme results in asymptomatic patients. N Engl J Med. 2000;342(17):1266-71. https://doi.org/10.1056/NEJM200004273421707
Goldberg DM, Martin JV. Role of gamma-glutamyl transpeptidase activity in the diagnosis of hepatobiliary disease. Digestion 1975;12(4-6):232-46. https://doi.org/10.1159/000197682
Lampignano L, Donghia R, Griseta C, Lagravinese G, Sciarra S, Zupo R, et al. Liver Health and Dementia in an Italian Older Population: Findings From the Salus in Apulia Study. Front Aging Neurosci. 2021;13:748888. https://doi.org/10.3389/fnagi.2021.748888
Rosalki SB, Tarlow D, Rau D. Plasma gamma-glutamyl transpeptidase elevation in patients receiving enzyme-inducing drugs. Lancet 1971;2(7720):376-7. https://doi.org/10.1016/S0140-6736(71)90093-6
Abdelaal E, Omar N, Zaghla H, Ehsan NA. Role of Gamma Glutamyl Transferase in patients with chronic hepatitis C virus infection. Tanta Medical Journal. 2007;35(Suppl):399-406.
Hwang SJ, Luo JC, Lai CR, Chu CW, Tsay SH, Lu CL, et al. Clinical, virologic and pathologic significance of elevated serum gamma-glutamyl transpeptidase in patients with chronic hepatitis C. Zhonghua Yi Xue Za Zhi (Taipei). 2000;63(7):527-35.
Sezer S, Ozdemir BH, Arat Z, Turan M, Ozdemir NF, Haberal M. Spectrum of liver damage and correlation with clinical and laboratory parameters in HCV infected hemodialysis patients. Ren Fail. 2001;23(6):807-18. https://doi.org/10.1081/JDI-100108192
Silva IS, Ferraz ML, Perez RM, Lanzoni VP, Figueiredo VM, Silva AE. Role of gamma-glutamyl transferase activity in patients with chronic hepatitis C virus infection. J Gastroenterol Hepatol. 2004;19(3):314-8. https://doi.org/10.1111/j.1440-1746.2003.03256.x
Sun Z, Chai J, Zhou Q, Xu J. Establishment of gender- and age-specific reference intervals for serum liver function tests among the elderly population in northeast China: a retrospective study. Biochem Med (Zagreb). 2022;32(2):020707. https://doi.org/10.11613/BM.2022.020707
Gatselis NK, Zachou K, Koukoulis GK, Dalekos GN. Hepatitis autoinmune, una enfermedad con muchas caras: Características etiopatogenéticas, clínico-laboratoriales e histológicas. World J Gastroenterol. 2015;21(1):60-83. https://doi.org/10.3748/wjg.v21.i1.60
Granito A, Muratori L, Pappas G, Muratori P, Ferri S, Cassani F, et al. Clinical features of type 1 autoimmune hepatitis in elderly Italian patients. Aliment Pharmacol Ther. 2005;21(10):1273-7. https://doi.org/10.1111/j.1365-2036.2005.02488.x
Montano-Loza AJ, Carpenter HA, Czaja AJ. Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease. Hepatology. 2007;46(4):1138-45. https://doi.org/10.1002/hep.21787
Czaja AJ, Carpenter HA. Distinctive clinical phenotype and treatment outcome of type 1 autoimmune hepatitis in the elderly. Hepatology. 2006;43(3):532-8. https://doi.org/10.1002/hep.21074
Zhang Y, Sun WL, Jin DL, Jing-Hua D. Clinical features of elderly Chinese patients with autoimmune hepatitis. Turk J Gastroenterol. 2013;24(6):489-94. https://doi.org/10.4318/tjg.2013.0592
Al-Chalabi T, Boccato S, Portmann BC, McFarlane IG, Heneghan MA. Autoimmune hepatitis (AIH) in the elderly: a systematic retrospective analysis of a large group of consecutive patients with definite AIH followed at a tertiary referral centre. J Hepatol. 2006;45(4):575-83. https://doi.org/10.1016/j.jhep.2006.04.007
Chen J, Eslick GD, Weltman M. Systematic review with meta-analysis: clinical manifestations and management of autoimmune hepatitis in the elderly. Aliment Pharmacol Ther. 2014;39(2):117-24. https://doi.org/10.1111/apt.12563
Lohse AW, Sebode M, Bhathal PS, Clouston AD, Dienes HP, Jain D, et al. Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology. Liver Int. 2022;42(5):1058-69. https://doi.org/10.1111/liv.15217
Czaja AJ, Carpenter HA. Sensitivity, specificity, and predictability of biopsy interpretations in chronic hepatitis. Gastroenterology. 1993;105(6):1824-32. https://doi.org/10.1016/0016-5085(93)91081-R
Abe K, Fujita M, Hayashi M, Takahashi A, Ohira H. Association of serum 25-hydroxyvitamin D levels with severe necroinflammatory activity and inflammatory cytokine production in type I autoimmune hepatitis. PLoS One. 2020;15(11):e0239481. https://doi.org/10.1371/journal.pone.0239481
Badiani RG, Becker V, Perez RM, Matos CA, Lemos LB, Lanzoni VP, et al. Is autoimmune hepatitis a frequent finding among HCV patients with intense interface hepatitis? World J Gastroenterol. 2010;16(29):3704-8. https://doi.org/10.3748/wjg.v16.i29.3704
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Revista colombiana de Gastroenterologia
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
Los autores/as ceden sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación en esta revista.
Los contenidos están protegidos bajo una licencia de Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional.
| Métricas do artigo | |
|---|---|
| Vistas abstratas | |
| Visualizações da cozinha | |
| Visualizações de PDF | |
| Visualizações em HTML | |
| Outras visualizações | |
