Autoimmune hepatitis is classically a disease of young women.Our aims were to determine its occurrence,clinical phenotype,and outcome in elderly patients and contrast findings to young adults.Two-hundred-and-five whit...Autoimmune hepatitis is classically a disease of young women.Our aims were to determine its occurrence,clinical phenotype,and outcome in elderly patients and contrast findings to young adults.Two-hundred-and-five white North American adults with definite type 1 autoimmune hepatitis were grouped according to age at presentation and the groups compared.Forty-seven patients(23%)were aged≥60 years(median age,68 years),and 31 patients(15%)were aged ≤30 years(median age,25 years).The patients ≥60 years had a higher frequency of cirrhosis at presentation than the patients ≤30 years(33%versus 10%,P =.03).They also had thyroid or rheumatic diseases more commonly(42%vs.13%,P =.006).HLA DR3 occurred more frequently in the patients ≤30 years than in those ≥60 years(58%vs.23%,P =.004),and HLA DR4 occurred more often in the patients≥60 years(47%vs.13%,P =.003).Patients aged ≥60 years failed corticosteroid treatment less commonly than those aged ≤30 years(5%vs.24%,P =.03).Autoimmune hepatitis occurred in patients aged 18-30 years(15%),31-39 years(15%),40-49 years(21%),50-59 years(25%),and ≥60 years(23%).Differences in age distribution,HLA frequencies,and treatment outcome occurred after age ≥40 years.In conclusion,elderly patients have a greater frequency of cirrhosis at presentation and HLA DR4 than patients ≤30 years,and they have a lower occurrence of treatment failure.Transitions in clinical and genetic phenotypes occur after age ≥40 years.Genetic susceptibilities may favor etiologic factors that are age-related.展开更多
Thiopurine methyltransferase deficiency has been associated with intolerance to azathioprine.Our goals were to assess the frequency of enzyme deficiency in autoimmune hepatitis and correlate deficiency states with aza...Thiopurine methyltransferase deficiency has been associated with intolerance to azathioprine.Our goals were to assess the frequency of enzyme deficiency in autoimmune hepatitis and correlate deficiency states with azathioprine intolerance.Eighty-six patients receiving azathioprine(50-150 mg daily) were evaluated for enzyme activity and azathioprine-related complications.Their findings were compared to 89 similarly treated but untested patients.Thirteen patients(15%) had low thiopurine methyltransferase levels(11.4± 0.9 U/ml RBC;range,3.5-14.9 U/ml RBC) .Azathioprine intolerance occurred as commonly in patients with normal or above normal enzyme levels as in patients with below normal levels(12% versus 15%,p = 0.7) .Patients treated without enzyme testing had the same frequency of complications(9% versus 13%,p = 0.5) as tested patients.We conclude that routine screening of blood thiopurine methyltransferase levels has a low yield for identifying individual patients at risk for azathioprine toxicity during conventional low dose therapy for autoimmune hepatitis.展开更多
Our aims were to determine the frequency of antibodies to Saccharomyces cerevisiae in autoimmune hepatitis and assess associations with concurrent mucosal diseases, genetic factors,and corticosteroid response. Seropos...Our aims were to determine the frequency of antibodies to Saccharomyces cerevisiae in autoimmune hepatitis and assess associations with concurrent mucosal diseases, genetic factors,and corticosteroid response. Seropositivity was determined by enzyme immunoassay in 385 samples obtained from 178 patients.Antibodies to Saccharomyces cerevisiae were detected in 49 patients (28% ), and serum levels of immunoglobulin A were higher in seropositive patients (410 ± 35 versus 321 ± 20 mg/dL; P=0.02). Individuals with and without antibodies were not otherwise distinguished by concurrent mucosal diseases, laboratory findings, or outcomes. Antibodies to tissue transglutaminase occurred more commonly in seropositive patients (16 versus 4% ; P=0.008), but this association was lost when corroborating serological criteria for celiac disease were sought. We conclude that antibodies to Saccharomyces cerevisiae are common in autoimmune hepatitis. They may be associated with non-disease-specific immune responses, but they do not define individuals with a distinctive clinical phenotype,associated mucosal diseases, or treatment outcome.展开更多
文摘Autoimmune hepatitis is classically a disease of young women.Our aims were to determine its occurrence,clinical phenotype,and outcome in elderly patients and contrast findings to young adults.Two-hundred-and-five white North American adults with definite type 1 autoimmune hepatitis were grouped according to age at presentation and the groups compared.Forty-seven patients(23%)were aged≥60 years(median age,68 years),and 31 patients(15%)were aged ≤30 years(median age,25 years).The patients ≥60 years had a higher frequency of cirrhosis at presentation than the patients ≤30 years(33%versus 10%,P =.03).They also had thyroid or rheumatic diseases more commonly(42%vs.13%,P =.006).HLA DR3 occurred more frequently in the patients ≤30 years than in those ≥60 years(58%vs.23%,P =.004),and HLA DR4 occurred more often in the patients≥60 years(47%vs.13%,P =.003).Patients aged ≥60 years failed corticosteroid treatment less commonly than those aged ≤30 years(5%vs.24%,P =.03).Autoimmune hepatitis occurred in patients aged 18-30 years(15%),31-39 years(15%),40-49 years(21%),50-59 years(25%),and ≥60 years(23%).Differences in age distribution,HLA frequencies,and treatment outcome occurred after age ≥40 years.In conclusion,elderly patients have a greater frequency of cirrhosis at presentation and HLA DR4 than patients ≤30 years,and they have a lower occurrence of treatment failure.Transitions in clinical and genetic phenotypes occur after age ≥40 years.Genetic susceptibilities may favor etiologic factors that are age-related.
文摘Thiopurine methyltransferase deficiency has been associated with intolerance to azathioprine.Our goals were to assess the frequency of enzyme deficiency in autoimmune hepatitis and correlate deficiency states with azathioprine intolerance.Eighty-six patients receiving azathioprine(50-150 mg daily) were evaluated for enzyme activity and azathioprine-related complications.Their findings were compared to 89 similarly treated but untested patients.Thirteen patients(15%) had low thiopurine methyltransferase levels(11.4± 0.9 U/ml RBC;range,3.5-14.9 U/ml RBC) .Azathioprine intolerance occurred as commonly in patients with normal or above normal enzyme levels as in patients with below normal levels(12% versus 15%,p = 0.7) .Patients treated without enzyme testing had the same frequency of complications(9% versus 13%,p = 0.5) as tested patients.We conclude that routine screening of blood thiopurine methyltransferase levels has a low yield for identifying individual patients at risk for azathioprine toxicity during conventional low dose therapy for autoimmune hepatitis.
文摘Our aims were to determine the frequency of antibodies to Saccharomyces cerevisiae in autoimmune hepatitis and assess associations with concurrent mucosal diseases, genetic factors,and corticosteroid response. Seropositivity was determined by enzyme immunoassay in 385 samples obtained from 178 patients.Antibodies to Saccharomyces cerevisiae were detected in 49 patients (28% ), and serum levels of immunoglobulin A were higher in seropositive patients (410 ± 35 versus 321 ± 20 mg/dL; P=0.02). Individuals with and without antibodies were not otherwise distinguished by concurrent mucosal diseases, laboratory findings, or outcomes. Antibodies to tissue transglutaminase occurred more commonly in seropositive patients (16 versus 4% ; P=0.008), but this association was lost when corroborating serological criteria for celiac disease were sought. We conclude that antibodies to Saccharomyces cerevisiae are common in autoimmune hepatitis. They may be associated with non-disease-specific immune responses, but they do not define individuals with a distinctive clinical phenotype,associated mucosal diseases, or treatment outcome.
