摘要
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.
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%）, 31-39years （15%）, 40-49years （21%）, 50-59 years （25%）, and ≥ ences in age distribution, HLA 60 years （23%） . Differfrequencies, 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,
