학술논문
Prevalence and significance of antimitochondrial antibodies in autoimmune hepatitis (AIH): Results from a large multicentre study of the International AIH Group.
Document Type
Academic Journal
Author
Gatselis NK; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.; Zachou K; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.; Loza AJM; Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Canada.; Cançado ELR; University of Sao Paulo, School of Medicine, Department of Gastroenterology, Sao Paulo, Brazil.; Arinaga-Hino T; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.; Muratori P; Division of Internal Medicine, Morgagni-Pierantoni Hospital, Forlì 47100, Department of Science for the Quality of Life, University of Bologna, Bologna, Italy.; Efe C; Department of Gastroenterology, Gazi Yaşargil Education and Research Hospital, Diyarbakir, Turkey.; Floreani A; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Scientific Institute for Research, Hospitalization and Healthcare, Negrar, Verona, Italy.; Invernizzi P; Division of Gastroenterology, Centre for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy.; Takahashi A; Department of Gastroenterology, Fukushima Medical University School of Medicine Fukushima, Japan.; Takaki A; Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.; Beretta-Piccoli BT; Epatocentro Ticino & Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.; van Hoek B; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.; Lytvyak E; Division of Preventive Medicine, University of Alberta, Edmonton, Canada.; Guedes LV; University of Sao Paulo, School of Medicine, Department of Gastroenterology, Sao Paulo, Brazil.; Purnak T; Department of Gastroenterology, Hacettepe University, Ankara, Turkey.; Cazzagon N; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.; Lygoura V; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.; Arvaniti P; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.; Rigopoulou EI; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece.; Muratori L; Division of Internal Medicine, Morgagni-Pierantoni Hospital, Forlì 47100, Department of Science for the Quality of Life, University of Bologna, Bologna, Italy.; Dalekos GN; Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece. Electronic address: dalekos@med.uth.gr.
Source
Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 9003220 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0828 (Electronic) Linking ISSN: 09536205 NLM ISO Abbreviation: Eur J Intern Med Subsets: MEDLINE
Subject
Language
English
Abstract
Background & Aims: Antimitochondrial antibodies (AMA) are specific markers for the diagnosis of primary biliary cholangitis (PBC) but can also be found occasionally in patients with autoimmune hepatitis (AIH). The present large multicentre cohort study assessed the prevalence and significance of AMA in AIH-patients.
Methods: 123 AMA-positive AIH-patients were investigated and compared with 711 age-matched AMA-negative AIH-patients and 69 patients with AIH/PBC variant.
Results: AMA prevalence in AIH-patients was 5.1% (range: 1.2%-11.8%). AMA-positivity was associated with female sex (p = 0.031) in AMA-positive AIH-patients but not with liver biochemistry, bile duct injury on liver biopsy, disease severity at baseline and response to treatment compared to AMA-negative AIH-patients. Comparing AMA-positive AIH-patients to those with AIH/PBC variant, there was no difference in disease severity. Regarding liver histology, AIH/PBC variant patients were characterized by the presence of at least one feature of bile duct damage (p<0.001). Response to immunosuppressive treatment was similar among groups. From AMA-positive AIH patients only those with evidence of non-specific bile duct injury had higher risk to progress to cirrhosis (HR=4.314, 95%CI: 2.348-7.928; p<0.001). During follow-up, AMA-positive AIH-patients had higher risk to develop histological bile duct injury (HR 4.654, 95%CI 1.829-11.840; p = 0.001).
Conclusions: AMA presence is relatively common among AIH-patients, but their clinical significance seems important only when they co-exist with non-specific bile duct injury at the histological level. Therefore, a careful evaluation of liver biopsy seems of utmost importance in these patients.
Competing Interests: Declaration of Competing Interest The following authors have no relevant financial or non-financial interests to disclose: N.K. Gatselis, K. Zachou, E.L.R. Cançado, T. Arinaga-Hino, P. Muratori, C. Efe, A. Floreani, A. Takahashi, A. Takaki, B. Terziloli Beretta-Piccoli, B. van Hoek, E. Lytvyak, L. Vilar Guedes, T. Purnak, N. Cazzagon, V. Lygoura, P. Arvaniti, E.I. Rigopoulou, L. Muratori, G.N. Dalekos. A.J. Montano Loza has received funding from the University of Alberta Hospital Foundation (UHF) and the Canadian Liver Foundation (CLF). P. Invernizzi has received research, and implementation grants by Abbvie, Intercept, Gilead.
(Copyright © 2023. Published by Elsevier B.V.)
Methods: 123 AMA-positive AIH-patients were investigated and compared with 711 age-matched AMA-negative AIH-patients and 69 patients with AIH/PBC variant.
Results: AMA prevalence in AIH-patients was 5.1% (range: 1.2%-11.8%). AMA-positivity was associated with female sex (p = 0.031) in AMA-positive AIH-patients but not with liver biochemistry, bile duct injury on liver biopsy, disease severity at baseline and response to treatment compared to AMA-negative AIH-patients. Comparing AMA-positive AIH-patients to those with AIH/PBC variant, there was no difference in disease severity. Regarding liver histology, AIH/PBC variant patients were characterized by the presence of at least one feature of bile duct damage (p<0.001). Response to immunosuppressive treatment was similar among groups. From AMA-positive AIH patients only those with evidence of non-specific bile duct injury had higher risk to progress to cirrhosis (HR=4.314, 95%CI: 2.348-7.928; p<0.001). During follow-up, AMA-positive AIH-patients had higher risk to develop histological bile duct injury (HR 4.654, 95%CI 1.829-11.840; p = 0.001).
Conclusions: AMA presence is relatively common among AIH-patients, but their clinical significance seems important only when they co-exist with non-specific bile duct injury at the histological level. Therefore, a careful evaluation of liver biopsy seems of utmost importance in these patients.
Competing Interests: Declaration of Competing Interest The following authors have no relevant financial or non-financial interests to disclose: N.K. Gatselis, K. Zachou, E.L.R. Cançado, T. Arinaga-Hino, P. Muratori, C. Efe, A. Floreani, A. Takahashi, A. Takaki, B. Terziloli Beretta-Piccoli, B. van Hoek, E. Lytvyak, L. Vilar Guedes, T. Purnak, N. Cazzagon, V. Lygoura, P. Arvaniti, E.I. Rigopoulou, L. Muratori, G.N. Dalekos. A.J. Montano Loza has received funding from the University of Alberta Hospital Foundation (UHF) and the Canadian Liver Foundation (CLF). P. Invernizzi has received research, and implementation grants by Abbvie, Intercept, Gilead.
(Copyright © 2023. Published by Elsevier B.V.)