Comparison of the simplified criteria and conventional criteria for the diagnosis of autoimmune hepatitis
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摘要: 目的早期、准确、及时地诊断自身免疫性肝炎(AIH)对该病的预后至关重要。本文对国际AIH协作组1999年制定的积分诊断标准(下称传统标准)和2008年制定的简化标准对国人AIH诊断的一致性进行了研究。方法按照传统标准筛选北京协和医院1995年1月~2010年12月16年间诊治的63例AIH患者,对其临床资料进行回顾性研究,并以简化标准再次进行诊断评分,比较两种标准诊断的一致性。结果以传统标准诊断AIH患者63例,女性55例,男性8例,平均年龄(45.0±17.3)岁,其中确诊患者36例,疑诊27例。以简化标准诊断时,45例诊断为AIH,两种标准的总体诊断一致性为71.4%(45/63)。以传统标准确诊的36例患者中,以简化标准诊断14例为确诊,15例为疑诊,7例为否定诊断;以传统标准疑诊的27例患者中,以简化标准诊断5例为确诊,11例为疑诊,11例为否定诊断。诊断降级的33例病例中,24例IgG正常,21例缺病理检查结果;19例同时具备其他自身抗体,14例合并其他自身免疫病。诊断升级的5例病例中,男性2例,1例有确切用药史,2例抗线粒体抗体阳性,5例均具备病理检查结果。单因素及多因素回...Abstract: Objective The present study is to evaluate the accordance and discrepancy between the simplified criteria and conventional criteria for the diagnosis of autoimmune hepatitis (AIH) in Chinese patients.Methods The medical records of 63 AIH patients diagnosed by the conventional criteria in Peking Union Medical College Hospital from 1995 to 2010 were retrospectively reviewed and reevaluated by the simplified criteria.The accordance and discrepancy between the two criteria were identified.Results Among the 63 patients diagnosed by the conventional criteria, 55 were female and 8 were male, with an average age of 45.0±17.3 years.Thirty-six patients were diagnosed as definite AIH, among which 14 were diagnosed as definite AIH, 15 as probable AIH and 5 as not having AIH by the simplified criteria.Twenty-seven patients were diagnosed as probable AIH by the conventional criteria, among which 5 were diagnosed as definite AIH, 11 as probable AIH and 11 as not having AIH by the simplified criteria.The overall accordance rate between the two criteria was 71.4% (45/63) .Among the 33 patients with downgraded diagnosis, 24 had normal IgG levels, 21 had no liver biopsy, 19 had other defined autoantibodies and 14 had concomitant autoimmune diseases.Among the 5 patients with upgraded diagnosis, 2 were male, 1 had drug history, 2 had positive AMA and 5 had liver biopsy.Serum IgG level (P≤0.001) and pathological findings (P<0.001) were significantly different between the accordant and downgraded groups by both univariate and multivariate analyses.Conclusion The simplified criteria relies more on liver pathology and is suggested to be used in patients with typical clinical features.For those with atypical features but highly suspected as AIH, the conventional criteria is the criteria of choice.
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Key words:
- hepatitis /
- autoimmune
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