Brief Article
Copyright ©2012 Baishideng. All rights reserved.
World J Hepatol. Sep 27, 2012; 4(9): 262-267
Published online Sep 27, 2012. doi: 10.4254/wjh.v4.i9.262
Centrilobular necrosis in acute presentation of Japanese patients with type 1 autoimmune hepatitis
Kazumichi Abe, Yukiko Kanno, Ken Okai, Fumiko Katsushima, Kyoko Monoe, Hironobu Saito, Atsushi Takahashi, Junko Yokokawa, Hiromasa Ohira
Kazumichi Abe, Yukiko Kanno, Ken Okai, Fumiko Katsushima, Kyoko Monoe, Hironobu Saito, Atsushi Takahashi, Junko Yokokawa, Hiromasa Ohira, Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan
Author contributions: Abe K and Kanno Y performed the majority of experiments; Okai K, Katsushima F, Monoe K, Saito H, Takahashi A and Yokokawa J provided the collection of human material; Abe K and Ohira H designed the study and wrote the manuscript.
Correspondence to: Kazumichi Abe, MD, Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Japan. k-abe@fmu.ac.jp
Telephone: +81-24-5471202 Fax: +81-24-5472055
Received: December 26, 2011
Revised: June 28, 2012
Accepted: August 23, 2012
Published online: September 27, 2012
Abstract

AIM: To compare clinicopathological features of acute presentation of type 1 autoimmune hepatitis (AIH) with or without centrilobular necrosis (CN).

METHODS: Our study comprised 41 patients with biopsy-proven acute presentation (acute exacerbation phase 36, acute hepatitis phase 5) of type 1 AIH at our hospital from 1975 to 2009. Elevated serum alanine aminotransferase (ALT) (> 5x upper limit of normal) identified acute presentation of the disease. We compared clinicopathological features of these AIH patients with or without CN. The data used for analysis included patient background (age, sex, type of disease, presence of complications with other autoimmune diseases, human leukocyte antigen, and International Autoimmune Hepatitis Group score), clinical parameters at presentation (ALT, alkaline phosphatase, IgG, anti-nuclear antibodies, and anti-smooth muscle antibodies), histology and therapy.

RESULTS: CN was found in 13 (31.7%) patients with acute presentation (acute exacerbation phase 10, acute hepatitis phase 3) of AIH. Serum IgG levels of patients with CN were significantly lower than those of patients without CN (mean: 2307 mg/dL vs 3126 mg/dL, P < 0.05), while antinuclear antibody-negative rates were significantly higher (30.7% vs 3.5%, P < 0.05). However, other clinical features were similar between the two groups. The frequency of advanced fibrosis in patients with CN was significantly lower than in patients without CN (F0-2: 84.6% vs 35.7%, F3-4: 15.4% vs 64.3%, P < 0.05). Other histological features were similar between the two groups. Although there was no significant difference between groups when evaluated using the revised original score (12 vs 14), the simplified AIH score of patients with CN was significantly lower (6 vs 7, P < 0.05). Frequency of DR4 was similar between patients with and without CN.

CONCLUSION: CN is observed in both Japanese patients with acute hepatitis phase and acute exacerbation phase of type 1 AIH, although AIH with CN often shows clinical features of the genuine acute form.

Keywords: Autoimmune hepatitis; Centrilobular necrosis; Acute presentation; Acute exacerbation phase; Acute hepatitis phase