Features of autoimmune hepatitis in perimenopausal women: a retrospective study

Background. It is known that sex hormones, incl. estrogens, affect the immune system in a complex way, and play an important role in the pathophysiology of autoimmune diseases. Three quarters of all patients with autoimmune diseases are women. Despite this, autoimmune diseases are rarely discussed as a women’s health problem. Objective. Comparison of the differences in the course of autoimmune hepatitis (AIH) in women of the reproductive, perimenopausal and postmenopausal periods: clinical, biochemical, serological and morphological parameters, as well as the response to immunosuppressive therapy (1ST). Methods. A retrospective study included 67 patients with AIH diagnosed according to the simplified AIHG criteria (2008). A comparative analysis of three groups of patients at different stages of reproductive aging was based on the clinical, laboratory and instrumental data obtained. Results. 67 patients were retrospectively analyzed for clinical, biochemical, immunological, morphological features, as well as the response to 1ST. When comparing 3 groups of AIH women of the reproductive (21 [31.3%]), perimenopausal (19 [28.3%]) and postmenopausal periods (27 [40.3%]), significant differences in clinical manifestation were revealed: in reproductive age an active debut, represented by the clinical and laboratory manifestation, was observed in 71.4% (15/21 patients), while in the group of perimenopausal and postmenopausal periods, disease symptoms were detected in 36.8% (7/19) and 29.6% (8/27) cases, respectively. When comparing the average values of alanine aminotransferase, Y-glutamyl transpeptidase, total bilirubin, and immunoglobulin G levels, patients of the 3 groups had differences, which manifested themselves in a significant decrease in the level of biochemical activity in the perimenopausal and further postmenopausal periods. By the number of seropositive patients, all 3 groups had no significant differences; antibodies were detected in 50-60% of cases. Among patients of perimenopausal and postmenopausal periods, AIH at the stage of hepatic cirrhosis (HC) was detected in 26.3% (5/19 patients) and 33.3% (9/27) versus 9.52% (2/21) women of reproductive age. Among the patients of the study group who were on IST, 61.9% (13/21) responded to IST in the reproductive age group, 68.4% (13/19) - in perimenopausal, and 66.7% (18/19) - in postmenopausal group. The number of cases of relapse was equal in all three groups. The presence of concomitant autoimmune-associated conditions was observed in an equal percentage of cases among perimenopausal and postmenopausal patients - 42.1 versus 40.7%, and 28.6% among women of the reproductive age. Conclusion. The analysis revealed a number of features in perimenopausal women with AIH: a more frequent indolent course of the disease and a greater number of patients diagnosed with AIH at the stage of HC at the time of diagnosis; histological and biochemical activity is lower than in the group of the reproductive age. In this group, a relatively more frequent detection of an atypical histological picture was observed. All postmenopausal patients on IST achieved the remission of the disease, but relapse was more common after end of the treatment. There was also a more frequent incidene of immuno-associated diseases in postmenopausal women. The variety of clinical manifestations of AIH depending on the hormonal background and age requires further evaluation.

autoimmune hepatitis, perimenopausal period, postmenopausal period, immunosuppressive therapy, immuno-associated diseases