Autoimmune Hepatitis its diagnosis and types

     

Most frequently women

–       ages 10-30 or late middle age

–       May mimic acute viral hepatitis in presentation

–       Numerous extrahepatic manifestations

–       Types 1,2,3

      Moderately elevated transaminases

      Hypergammaglobulinemia

    more than 80% of patients   SPEP - more than 2x normal of polyclonal IgG suggestive of diagnosis

      ANA

–       >1:40 titer for significance

–       28% sensitivity

      SMA

–       Directed against F-actin

      >1:80 titer

–       May be only marker of autoimmune hepatitis at high titer

–       40% sensitivity

–       May have low + titers in chronic viral hepatitis, but lack F-actin specificity

      Liver-kidney microsomal antibodies (LKM)

–       Target antigen is cytochrome P450 2D6

–       Predominantly marker of autoimmune hepatitis type 2

–       Rarely positive in patients in US, Australia, Japan

      Antibodies to cytosolic antigens (SLA, LP)

–       May be only markers in when ANA, SMA, LKM neg.

      Autoantibodies to hepatocellular membrane antigens (ASPGR)

–       May be + when all other tests negative and still suspect diagnosis

      Anti-mitochondrial antibodies (AMA)

–       Should be negative