Clinical and histological features of autoantibody-negative autoimmune hepatitis in Chinese patients: A single center experience

Authors

  • Qi Xia Wang,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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    • These authors contributed equally to this article.
  • Wei Jun Jiang,

    1. Department of Gastroenterology, St Luke's Hospital, Renji Hospital Changning Branch, , Shanghai Jiao Tong University School of Medicine, Shanghai, China
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    • These authors contributed equally to this article.
  • Qi Miao,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Xiao Xiao,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Hai Yan Zhang,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Shan Shan Huang,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Lei Shen,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Jing Hua,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Hai Li,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Shen Li,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • De Kai Qiu,

    1. Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Xiong Ma

    Corresponding author
    • Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Diseases, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Shanghai Jiao Tong University, Shanghai, China
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  • Conflict of interest: None.

Correspondence to: Xiong MA, Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, 145 Shandong Zhong Road, Shanghai 200001, China. Email: maxiongmd@hotmail.com

Abstract

Objective

This study aimed to define the clinical features of Chinese patients with autoantibody-negative autoimmune hepatitis (AIH) and to refine the diagnosis and management of these atypical patients in a single Chinese center.

Methods 

A retrospective evaluation of 167 Chinese patients with AIH was performed. Patients meeting comprehensive criteria with the absence of antinuclear antibodies, smooth muscle antibodies, liver-kidney microsomal-1 antibodies and antimitochondrial antibodies were defined as autoantibody-negative patients.

Results 

In total, 17 (10.2%) of the 167 patients with AIH were autoantibody-negative. The general status and biochemical tests between the classical and autoantibody-negative patients were not significantly different (P > 0.05). Serum immunoglobulin G levels of the autoantibody-negative AIH patients were lower than those of the classical AIH ones (P = 0.004). There was no significant difference in the histological inflammatory grades between the two groups; however, advanced histological stages were more common in the autoantibody-negative AIH group (P < 0.001). In the autoantibody-negative AIH patients, 11 (64.7%) had a possible diagnosis and 6 (35.3%) had a definite diagnosis according to the comprehensive criteria. While with the simplified criteria only 3 patients (17.6%) had a possible diagnosis, and none had a definite diagnosis of AIH. The complete biochemical remission rate was 86% within 24 months of immunosuppressive therapy, which was comparable to classical AIH (P = 0.658).

Conclusion

Autoantibody-negative AIH is not uncommon in Chinese AIH patients, and has a good response to immunosuppressive treatment comparable to classical patients.

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