[Characteristics of initial diagnosis in autoimmune liver disease: an 18-year, retrospective single-center study].

Objective: To analyze the chorological changes of diagnosis in patients with autoimmune liver disease (AILD) and related factors for early diagnosis. Methods: A total of 581 patients with age ranged from 16 to 81 were retrospectively analyzed, who were admitted to Tianjin Medical University General Hospital with AILD during January 2000 to December 2017. Age at diagnosis, diagnostic method and cirrhosis at diagnosis were compared in different groups according to admission period as 2000-2005, 2006-2011, 2012-2017. Results: The diagnostic rate of AILD showed an upward trend during the past near two decades. The proportion of AILD patients diagnosed via health examination was increasing year by year mainly by elevated transaminases (P<0.001). The mean age at diagnosis in our AILD patients were younger at present, especially in men (P=0.044). The proportion of cirrhosis at diagnosis was gradually reduced in three different periods respectively [77.78%(21/27), 41.58% (79/190), 25.00%(91/364), P<0.001], which were coincident in patients with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC) (P<0.001). The shrinking trend of cirrhosis at diagnosis was significantly correlated with the increasing application of health examination (r=-0.549, P<0.001). Conclusions: Extensive application of health examination expands the diagnostic rate of AILD. During the past 18 years, more young patients are diagnosed with AILD. The proportion of severe cases such as cirrhosis at diagnosis is decreasing. Screening of immunological examinations in patients with abnormal transaminases is needed and critical to the early diagnosis of asymptomatic AILD.目的：观察自身免疫性肝病（AILD）患者首诊特征的年代变迁，探讨对该病早期诊断有意义的因素。 方法：回顾性分析2000年1月至2017年12月就诊于天津医科大学总医院消化科的581例AILD患者资料，根据时间划分为3个年度段（2000至2005年，2006至2011年，2012至2017年），比较首诊年龄、诊断途径和首诊时合并肝硬化的年代变迁。 结果：2000至2017年本中心AILD诊断例数逐渐增多，年龄范围16~81岁。体检筛查发现肝功能异常作为AILD患者首诊途径的比例逐渐增多（P<0.001），因出现相关临床症状或肝硬化失代偿期表现而就诊的患者比例逐渐下降（P<0.001）。不同性别的AILD患者平均首诊年龄均有下降趋势，其中男性患者下降明显（P=0.044）。首诊时合并肝硬化的患者比例明显降低[上述3个年度段首诊肝硬化比例分别为77.78%（21/27）、41.58%（79/190）和25.00%（91/364），P<0.001]，其中自身免疫性肝炎和原发性胆汁性胆管炎患者首诊合并肝硬化比例下降较为显著（P<0.001）。首诊合并肝硬化的AILD患者的比例降低与健康体检作为首诊途径的比例逐年增多有明显相关性（r=-0.549，P<0.001）。 结论：近年来体检筛查发现肝功能异常作为AILD患者首诊途径的比例较过去明显升高，AILD患者首诊年龄呈下降趋势，首诊时合并肝硬化及并发症的比例明显降低。临床医师需对体检发现肝损伤人群进行规范的免疫学检查，重视无症状AILD患者的早期诊断。.