Autoimmune hepatitis in a Jamaican cohort spanning 40 years

摘要

BACKGROUND: The prevalence and characteristics of autoimmune hepatitis (AIH) in black populations are not well documented. OBJECTIVES: To describe the clinical and laboratory features of AIH in patients presenting at a Jamaican hospital, 1969-2009. METHODS: A retrospective review of hospital records was done and patients were classified by the revised international scoring system. RESULTS: Fifty patients satisfied criteria for diagnosis of AIH type-1 and most presented late at hospital. Almost one third of cases presented with chronic liver disease (32%) while 8% presented with fulminant hepatic failure and 2% with acute liver disease. Jaundice (92%) was the most common presenting feature. Other associated autoimmune diseases (10%) systemic lupus erythematosus and insulin dependent diabetes mellitus, were found. All patients (100%) had abnormal liver biochemical tests, 81% had hypergammaglobulinaemia and 82% AIH associated autoantibodies. The prevalence of autoantibodies increased with age (P=0.05). Liver biopsy, performed in 33 cases, showed chronic hepatitis (45%), cirrhosis (24%) chronic hepatitis with bridging necrosis (15%), chronic hepatitis with rosetting (6%) and nonspecific findings (10%). Patients were treated with prednisone with or without azathioprine. Relapse occurred in 4% and death 6%. CONCLUSION: Autoimmune hepatitis is rare in Jamaicans and prognosis is similar to that reported in developed countries.