The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Diagnostic Value and Utility of the Simplified International Autoimmune Hepatitis Group (IAIHG) Criteria for Autoimmune Hepatitis in Korea

한국인 자가면역성 간염을 진단하기 위한 Simplified Scoring Criteria의 가치 및 유용성

  • Lee, Yun-Nah (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Young-Seok (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Sang-Gyune (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lim, Jae-Hee (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jeong, Soung-Won (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jang, Jae-Young (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Se-Hwan (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Hong-Soo (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Boo-Sung (Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Hee-Kyung (Digestive Disease Center, Department of Pathology, Soonchunhyang University College of Medicine)
  • 이윤나 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 김영석 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 김상균 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 임재희 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 정승원 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 장재영 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 이세환 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 김홍수 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 김부성 (순천향대학교 의과대학 내과학교실 소화기연구소) ;
  • 김희경 (순천향대학교 의과대학 병리과학교실)
  • Published : 2011.09.01
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Abstract

Background/Aims: The diagnostic criteria for autoimmune hepatitis (AIH) were created and revised by the International Autoimmune Hepatitis Group (IAIHG) in 1999. Simplified scoring criteria based on four clinical components were recently proposed. The aim of this study was to assess the diagnostic value and usefulness of these simplified criteria in Korea. Methods: We applied the simplified scoring criteria to 22 AIH patients diagnosed according to the original revised scoring criteria proposed in 1999. Furthermore, in order to compare the predictive power of these two sets of diagnostic criteria, we included 84 patients with liver diseases [toxic hepatitis (n = 50), nonalcoholic fatty liver disease (n = 18), primary biliary cirrhosis (PBC) (n = 11), and PBC/AIH overlap syndrome (n = 5)] other than AIH. Results: Twenty (90.9%) patients with AIH and five (100%) with PBC/AIH overlap syndrome were diagnosed with AIH according to the simplified scoring criteria. Three (27.3%) patients with PBC were false-positive for AIH according to the simplified scoring criteria. Those patients diagnosed according to the simplified scoring criteria showed an increased frequency of ANA and/or SMA of ${\geq}$ 1:80 (p = 0.491) and an increased frequency of serum IgG levels at or above the upper normal limit compared to patients with PBC (p = 0.006). The sensitivity and specificity of the simplified scoring criteria for the diagnosis of AIH were 90.9 and 96.2%, respectively. Conclusions: The simplified scoring criteria offer a reliable and simple method for excluding AIH; however, these criteria may have limitations in the diagnosis of patients with atypical features, especially those with low autoantibody and IgG levels.

목적: 자가면역성 간염(AIH)을 진단하기 위한 revised original scoring criteria는 지나치게 번거로워 임상에서의 적용이 쉽지 않았다. 이러한 단점을 보안하기 위해 2008년 Hennes 등 [19]에 의해 simplified scoring criteria가 발표되었다. 이에 저자등은 이 criteria를 한국인에게 적용하였을 경우, 진단적 가치 및 유용성을 평가하고자 연구를 시행하였다. 방법: Original revised scoring criteria에 의해 AIH이 진단된 22예와 자가면역 간염/원발성담즙 간경변증(autoimmune hepatitis/primary biliary cirrhosis, AIH/PBC) 중복증후군을 진단받은 5예, 그리고 대조군으로 독성간염 50예, 비알코올성 지방간(NAFLD) 18예, 원발성담즙 간경변증(PBC) 11예를 후향적으로 분석하였다. 결과: AIH 중 20명(90.9%)과 AIH/PBC 중복 증후군 5명 모두가 simplified scoring criteria에 의해 AIH로 진단되었다. 그리고 PBC 중 3명인 27.3%에서 새로운 진단기준을 적용하였을 경우 위양성을 보였다. AIH 진단에 대한 simplified scoring criteria의 민감도와 특이도는 각각 90.9%와 96.2%였다. 결론: 한국인에게 simplified scoring criteria는 중복증후군을 포함한 자가면역성 간염을 진단하는 데 유용하게 사용될 수 있을 것으로 생각한다.

Keywords

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