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Overlap of concurrent extrahepatic autoimmune diseases is associated with milder disease severity of newly diagnosed autoimmune hepatitis

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Hepatobiliary & Pancreatic Diseases International 2021年第1期20卷 21-27页

作者： Tobias Mühling Helmut Rohrbach Wolfgang Schepp Felix Gundling Department of Gastroenterology Internal Medicine ⅡUniversity of WürzburgWürzburgGermany Department of Pathology Academic Teaching Hospital BogenhausenTechnical University of MunichMunich 81925Germany Department of Gastroenterology Hepatology and Gastrointestinal OncologyAcademic Teaching Hospital BogenhausenTechnical University of MunichMunich 81925Germany Department of Internal Medicine Division of GastroenterologyGastrointestinal Oncology and DiabetologyKemperhof KoblenzKoblenzGermany

Background:Concurrent extrahepatic autoimmune disorders(CEHAID)are frequently observed in autoimmune hepatitis(AIH).It is not clear whether there is any prognostic significance of CEHAID on AIH.The aim of this study was to examine the prognostic impact of CEHAID and the correlation with the disease severity of AIH.Methods:This study included 65 hospitalized subjects who fulfilled the accepted criteria for AIH during an 8-year period(2009–2016).All records were manually screened for presence of associated autoimmune diseases.Disease severity of AIH was assessed by liver laboratory tests including the ratio of aspartate aminotransferase to alanine aminotransferase(AST/ALT)and liver histology.Results:Among the enrolled patients,52(80%)were female(median age 61 years,IQR 45–75).Fifty-six(86.2%)were classified as type-1 AIH.In 26(40%)patients at least one additional extrahepatic autoimmune disease was diagnosed.Thirty-four subjects were referred to our hospital because of acute presentation of AIH(supposed by an acute elevation of hepatic enzymes)for subsequent liver biopsy resulting in initial diagnosis of AIH.This group was stratified into 3 subgroups:(A)AIH alone(n=14);(B)overlap with primary biliary cirrhosis(PBC)/primary sclerosing cholangitis(PSC)(n=11);and(C)with CEHAID(n=9).AST/ALT ratio was the lowest in subgroup C(median 0.64,IQR 0.51–0.94;P=0.023),compared to subgroup A(median 0.91,IQR 0.66–1.10)and subgroup B(median 1.10,IQR 0.89–1.36).Patients with AIH alone showed a trend to the highest grade of fibrosis(mean 2.3;95%CI:1.5–3.0)with no statistical significance compared to subjects with CEHAID(lowest grade of fibrosis;mean 1.5;95%CI:0.2–2.8;P=0.380)whereas the ongoing inflammation was comparable.Conclusions:AST/ALT ratio and extent of fibrosis were lower in subjects with AIH and CEHAID,compared to subjects with only AIH.Therefore,the occurrence of CEHAID might be a predictor for lower disease severity of newly diagnosed acute onset AIH,possibly caused by an earlier diagnosis or different modes of damage.

关键词： Autoimmune hepatitis Concurrent extrahepatic autoimmune disease Serum aminotransferase activities

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Clinical implications of diabetes in chronic liver disease:Diagnosis,outcomes and management,current and future perspectives

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World Journal of Gastroenterology 2022年第8期28卷 775-793页

作者： Diego García-Compeán Emanuela Orsi Ramesh Kumar Felix Gundling Tsutomu Nishida Jesús Zacarías Villarreal-Pérez Ángel N Del Cueto-Aguilera JoséA González-González Giuseppe Pugliese Gastroenterology Service and Department of Internal Medicine Faculty of MedicineUniversity Hospital“Dr.JoséE.González”Universidad Autónoma de Nuevo LeónMonterrey 64700Nuevo LeónMexico Diabetes Service Endocrinology and Metabolic Diseases UnitFdn IRCCS Ca GrandaEndocrine UnitPadigl GranelliMilan 20121Italy Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Department of Gastroenterology Gastrointestinal OncologyHepatologyDiabeticsMetabolism and Infectious DiseasesSozialstiftung BambergBamberg 96049Germany Department of Gastroenterology Toyonaka Municipal HospitalOsaka 560-8565Japan Department of Endocrinology University HospitalAutonomous University of Nuevo LeónMonterrey 64700Mexico Department of Gastroenterology and Internal Medicine Faculty of MedicineUniversity HospitalAutonomous University of Nuevo LeónMonterrey 64700Nuevo LeónMexico Gastroenterology Service and Department of Internal Medicine University Hospital Dr.JoséE González and Medical SchoolMonterrey 64460Nuevo LeónMexico Department of Clinical and Molecular Medicine La Sapienza UniversityRoma 00161Italy

Diabetes mellitus(DM)is common in liver cirrhosis(LC).The pathophysiological association is bidirectional.DM is a risk factor of LC and LC is a diabetogenic condition.In the recent years,research on different aspects of the association DM and LC has been intensified.Nevertheless,it has been insufficient and still exist many gaps.The aims of this review are:(1)To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis;(2)To evaluate the impact of DM on outcomes of LC patients;and(3)To select the most adequate management benefiting the two conditions.Literature searches were conducted using Pub Med,Ovid and Scopus engines for DM and LC,diagnosis,outcomes and management.The authors also provided insight from their own published experience.Based on the published studies,two types of DM associated with LC have emerged:Type 2 DM(T2 DM)and hepatogenous diabetes(HD).High-quality evidences have determined that T2 DM or HD significantly increase complications and death pre and post-liver transplantation.HD has been poorly studied and has not been recognized as a complication of LC.The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure.In conclusion,the clinical impact of DM in outcomes of LC patients has been the most studied item recently.Nevertheless many gaps still exist particularly in the management.These most important gaps were highlighted in order to propose future lines for research.

关键词： Diabetes mellitus Liver cirrhosis Hepatogenous diabetes Clinical implications Therapy

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