Liver, Pancreas, and Biliary Tract

Journal of Gastroenterology

, 32:769

First online:

Chronic hepatitis C associated with anti-liver/kidney microsome-1 antibody is not a subgroup of autoimmune hepatitis

  • Hiroshi MiyakawaAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Eriko KitazawaAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Kazuhiro AbeAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Naomi KawaguchiAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Hirotoshi FuzikawaAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Kentaro KikuchiAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Makoto KakoAffiliated withFourth Department of Internal Medicine, Teikyo University School of Medicine
  • , Tatsuji KomatsuAffiliated withClinical Research Institute, Yokohama National Hospital
  • , Naoaki HayashiAffiliated withInstitute of Gastroenterology, Tokyo Women's Medical College
    • , Kendo KiyosawaAffiliated withSecond Department of Internal medicine, Shinsyu University School of Medicine

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Abstract

To determine whether “autoimmune hepatitis type IIb” should be categorized as a subgroup of autoimmune hepatitis, we conducted a clinicopathological study of 25 adult Japanese patients who were positive for anti-liver/kidney microsome-1 (anti-LKM-1) antibody and infected with the hepatitis C virus (HCV). Anti-LKM-1 was determined by indirect immunofluo-rescence and by the double immunodiffusion assays we have developed. Twenty-two patients did not present any unusual symptoms or any associated diseases during the course of their chronic HCV infection. The spectrum of HCV genotypes of these patients did not significantly differ from that of anti-LKM-1-negative Japanese patients with chronic hepatitis C. Histological examination of liver biopsy specimens showed the usual characteristics of chronic hepatitis C and lack of characteristics of autoimmune hepatitis type I. No disease-specific HLA haplotypes were noted, and HLA-DR4, which is detectable in 88.7% of Japanese patients with autoimmune hepatitis type I, was detected in only 50.0% of our group, the same rate as the background frequency. Prednisolone was effective in none of the six patients treated, but interferon was effective in six of ten treated patients (60%). From these results, we conclude that “autoimmune hepatitis type IIb” should not be categorized as autoimmune hepatitis, and that this subgroup is essentially chronic hepatitis C in which an autoantibody has been produced during the course of chronic HCV infection.

Key words

autoimmune hepatitis type IIb HCV-RNA HCV genotype interferon HLA