Transient exacerbation after infections in patients with autoimmune hepatitis
Abstract
Aims
Although the pathogenesis of autoimmune hepatitis (AIH) is unknown, many recent studies have demonstrated that infection can act as a trigger for the onset of AIH. The existence of a pathogenetic link between AIH and infections has not been confirmed. If AIH is triggered by infections, it is possible that infections may transitorily worsen liver function in patients with AIH. We investigated the association between the effects of infections and the exacerbation of liver dysfunction in patients with AIH.
Methods
We determined the changes in liver function before and after infections in 20 patients with definite AIH, 33 with probable AIH, 24 with primary biliary cholangitis (PBC), 30 with chronic hepatitis C (CH(C)), and 23 control subjects.
Results
During the study period, 19 of the 20 patients (95%) with AIH experienced one or more signs ofliver dysfunction after infection. Seventy-three (59%) out of the 124 total occurrences of infectionsin 19 patients met the criteria for transient exacerbation of liver dysfunction. The incidence of liver dysfunction and the serum IgG levels after infection were significantly higher in the patients with definite AIH than in the patients with probable AIH, PBC and CH(C), and in the control subjects. Serum IgG level was a significant independent predictor of liver dysfunction.
Conclusion
The present study results suggested that infection was one cause of exacerbation of liver dysfunction in patients with AIH, and that serum IgG level was a significant independent predictor of exacerbation of liver dysfunction after infection.
Keywords
References
References
Krawitt EL. Autoimmune hepatitis. N Engl J Med 2006; 354: 54-66.
Vento S, Cainelli F. Is there a role for viruses in triggering autoimmune hepatitis? Autoimmun Rev 2003; 3: 61-69.
Ercolini AM, Miller SD. The role of infections in autoimmune disease. Clin Exp Immunol 2008; 155: 1-15.
Group members: Alvarez F, Berg PA, Bianchi FB, et al. International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 1999; 31: 929-938.
Rehermann B, Michitaka K, Durazzo M, Mergener K, Velev P, Manns MP. Viruses and auto-immune hepatitis. Eur J Clin Invest 1994; 24: 11-19.
Christen U, Hintermann E. Pathogen infection as a possible cause for autoimmune hepatitis. Inter Rev Immunol 2014; 33: 296-313.
Wucherfennig KW. Mechanisms for the induction of autoimmunity by infectious agents. J Clin Invest 2001; 108: 1097-1104.
Papic N, Pangercic A, Vargovic M, Barsic B, Vince A, Kuzman I. Liver involvement during influenza infection: perspective on the 2009 influenza pandemic. Influenza Other Resp Viruses 2012; 6: e2-e5.
Adams DH, Hubscher SG. Systemic viral infections and collateral damage in the liver. Am J Pathol 2006; 168: 1057-1059.
Shimizi Y. Liver in systemic disease. World J Gastroenterol 2008; 14: 4111-4119.
Lui Y, Huang T, Su M, Li J, Chen Z, Qiu Y, Liu X, Yan M Wang Y, Gu J. Expression and distribution of immu,nologlobulin G in the normal liver, hepatocarcinoma and postpartial hepatectomy liver. Lab Invest 2014; 94: 1283-1295.
Migliaccio G, Migliaccio AR, Petti S, Mavilio F, Russo G, Lazzaro D, Testa U, Marinucci M, Peschle C. Human embryonic hemopoiesis: kinetics of progenitors and precursors underlying the yolk sac ---liver transition. J Clin Invest 1986; 78: 51-60.
Gurevich P, Elhayany A, Ben-Hur H, Moldavsky M, Szvalb S, Zandbank J,Schneider DF, Zusman I. Secretory component, J chain, and immunoglobulins in human embryos and fetuses of the first trimester of pregnancy: immunohistochemical study. Peditr Dev Pathol 2002; 6: 35-42.
Maruyama S, Hirayama C, Horie Y, Yorozu K, Maeda K, Inoue M, Fujii Y, Umeki K,Koda M. Serum immunoglobulins in patients with chronic hepatitis: a surrogate marker of disease severity and treatment outcome. Hepato-Gastroenterol 2007; 54: 493-498.
Ohira H, Takahashi A. Current trends in the diagnosis and treatment of autoimmune hepatitis in Japan. Hepatol Res 2012; 42: 131-138.
Toda G, Zeniya M, Watanabe F, Imawari M, Kiyosawa K, Nishioka M, Tsuji T, Omata M. Present status of autoimmune hepatitis in Japan – correlating the characteristics with international criteria in an area with a high rate of HCV infection. J Hepatol 1997; 26: 1207-1212.
Yoshikawa M, Tsuji T, Matsumura K, Yamao J, Matsumura Y, Kubo R, Fukui H, Ishizaka S. Immunomodulatory effects of urosdeoxycholic acid on immune responses. Hepatology 1992; 16: 358-364.
Nakamura K, Yoneda M, Yokohama S, Tamori K, Sato Y, Aso K, Aoshima M, Hasegawa T, Makino I. Efficacy of ursodeoxycholic acid in Japanese patients with type 1 autoimmune hepatitis. J Gastroenterol Hepatol 1998; 13: 490-495.
Miyake Y, Iwasaki Y, Kobayashi H, Yasunaka T, Ikeda F, Takaki A, Okamoto R,Takaguchi K, Ikeda H, Makino Y, Ando M, Sakaguchi K, Yamamoto K. Efficacy of ursodeoxycholic acid for Japanese patients with autoimmune hepatitis. Hepatol Int 2009; 3: 556-562.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution 3.0 License.