Frequency of serological results of antibodies related to autoimmune hepatitis in Iranian patients with non-viral hepatitis

Frequency of serological results of antibodies related to autoimmune hepatitis in Iranian patients with non-viral hepatitis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Frequency of serological results of antibodies related to autoimmune hepatitis in Iranian patients with non-viral hepatitis Hamid Reza Ghasemi Basir, Alireza Khalilian, Anahita Eslami-Ghayour, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4300149/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Autoimmune hepatitis as a chronic inflammatory disease of the liver can occur when the body's immune system is stimulated against liver cells, but its exact cause is unknown. Autoimmune hepatitis, if left untreated, leads to liver damage or cirrhosis over time, which can eventually cause liver failure. Objective This descriptive-analytical study was done to assess the frequency of serological results of autoimmune hepatitis-related antibodies in patients with non-viral hepatitis referring to an inpatient clinic in 2019 and provide basic information for future studies and assistance in localization of external guidelines performed to diagnose autoimmune hepatitis. Methods All patients were evaluated for age and sex, ANA, ASMA, and LKM antibodies , and immunoglobulin by preparing 5 cc of blood samples using laboratory techniques and electrophoresis. The collected data were recorded in the checklist created by the researcher. Results The total number of 209 patients with non-viral hepatitis, with a mean age of 37.98 years participated in this study. In patients with non-viral hepatitis, 50.2% of patients had polyclonal hypergammaglobulinemia , in 17.2% ANA was positive, in 16.3% ASMA was positive, and 1.9% LKM was positive. Conclusion hypergammaglobulinemia, ANA, and ASMA are suitable antibodies for autoimmune hepatitis. Moreover, laboratory results of ANA and ASMA in patients with autoimmune hepatitis indicate low levels of these antibodies in Iran and their deficiency in other countries. Conventional diagnostic methods can provide a definitive diagnosis. Therefore, it shows the need for further examination of laboratory instruments and wider use of other diagnostic methods, including biopsy and further assessments. Serology Autoimmune hepatitis Epidemiology Antibody Figures Figure 1 1. Introduction Autoimmune hepatitis as a chronic inflammatory disease of the liver can occur when the immune system of the body is stimulated against liver cells. Its exact cause is unknown, but genetic and environmental factors seem to work together over time to develop the disease. Autoimmune hepatitis, if left untreated, leads to liver damage or cirrhosis over time, which can eventually lead to liver failure. The presence of circulating autoantibodies as well as elevated serum globulin levels can be observed in this disease. The disease may have an acute onset and progress to chronic hepatitis and even cirrhosis of the liver ( 1 ). Rejection of viral and medicinal hepatitis and liver biopsy and laboratory findings are the main factors for diagnosing autoimmune hepatitis. One of the characteristic laboratory findings in autoimmune hepatitis is an increase in serum levels of globulins, which are associated with circulating autoantibodies and are of the IgG type ( 2 ). Autoimmune hepatitis is classified into two types I and II according to the type of circulating antibodies: type I: ANA, ASMA, AAA, anti-SLA / LP, anti-dsDNA and anti-ssDNA or atypical p-ANCA and rarely AMA in the form of AIH-PBC overlap and type II: anti-LKM1 or ALC-1 in the bloodstream, and a titer of 1/80 for anti-LKM1 may be considered positive while a titer greater than 1/20 is positive for ANA and ASMA ( 3 , 4 ). About 20% of patients with autoimmune hepatitis lack circulating antibodies, including ANA, ASMA , or anti-LKM1 , known as autoantibody negative AIH or cryptogenic chronic hepatitis. In these patients, the therapeutic response to anti-inflammatory drugs may be the only clinical finding in favor of autoimmune hepatitis ( 3 , 4 ). Autoimmune hepatitis is diagnosed based on the rejection of other common diagnoses. According to a guideline by the American Association for the Study of Liver Disease (2010), in a person with increased serum concentrations of hepatic aminotransferases, at least twice the normal maximum after ruling out viral hepatitis, alcoholic liver disease, drug hepatitis, and measuring serum globulins and common antibodies including ANA, ASMA, LKM-1, AMA, gamma globin, and serum IgG is considered in the first stage. If common antibodies are negative, other antibodies, includin g ALC-1, SLA/LPAb , and atypical p-ANCA , are tested and magnetic resonance cholangiopancreatography (MRCP) is performed in people with a history of inflammatory bowel disease (IBD) or increased ALK l evels ( 5 ). Studies have shown low levels of antibodies in Iran compared to other communities, which has been attributed to different laboratory instruments. Diagnosis and treatment of autoimmune hepatitis patients should be based evidence-based, considering the prevalence of markers and antibodies. 2. Methods Patients who had chronic hepatitis with raised serum transaminase levels for at least 6 months and positive serology for viral hepatitis A, B, and C, and those with a possibility of drug-induced, alcoholic, or fatty liver hepatitis, were evaluated based on their clinical history and paraclinical findings in their follow-up visit after examining the results of the tests. If the diagnosis of viral hepatitis was ruled out, patients were evaluated for a possible diagnosis of autoimmune hepatitis. All patients underwent a biopsy, and histopathologically, they had chronic hepatitis with or without specific changes of autoimmune hepatitis. Electrophoresis of serum proteins to check electrophoretic patterns and polyclonal hypergammaglobulinemia were requested. In addition, 5 cc of venous blood was taken from the patient for serological tests including ANA, ASMA , and LKM . To standardize the diagnostic process and improve diagnostic accuracy in autoimmune hepatitis ( AIH ), a scoring system based on antibody titer, IgG or gammaglobulin serum level, liver histopathology, and rejection of viral hepatitis was designed( 1 , 6 , 18 ). The system assigned a score of 1 to ANA or ASMA titer of 1/40, and a score of 2 to ANA or ASMA titer of 1/80 or greater than or equal to 1/40 or positive SLA . A score of 1 was assigned if the level of serum IgG or gammaglobulin was higher than the maximum normal, and a score of 2 if it was more than 1.1 times the maximum normal. A score of 1 was assigned if the liver biopsy was compatible with AIH , and a score of 2 if it was typical of AIH ( 6 , 7 ). Typical diagnostic findings included interface hepatitis, lymphoplasmacytic infiltration in the portal tract with extension to the hepatic lobule, emperipolesis (active infiltration of a larger intracellular cell), and hepatic rosette formation. Compatible diagnosis findings included chronic hepatitis with lymphocytic infiltration in the absence of all typical findings. The absence of viral hepatitis based on tests related to hepatitis B and C was assigned a score of 2, and other types of viral hepatitis was considered on a case-by-case basis based on clinical findings. A final score of 6 or more indicated a probable or definite diagnosis of autoimmune hepatitis, respectively.The descriptive statistics section included mean and standard deviation for quantitative variables with normal distribution, and frequency and percentage for qualitative variables in the form of frequency distribution tables and graphs. The Chi-square test was used to compare qualitative variables. The data were analyzed using SPSS version 22 software, and a statistical significance level of less than 5% was considered. The study was conducted in the gastroenterology clinic of Shahid Beheshti Medical Training Hospital in Hamadan in 2019. The study population included patients referred to the clinic for follow-up on the cause of liver inflammation, with an increase in the level of liver enzymes AST and ALT (at least 2 times the maximum normal), after ruling out viral hepatitis, drug-induced, alcoholic, or fatty liver hepatitis. The study sample included 209 patients under investigation for the diagnosis of autoimmune hepatitis. The sample size was calculated based on Czaja et al.'s study in 2012( 3 ), titled "antibody-negative autoimmune hepatitis," which found the prevalence of antibody-negative autoimmune hepatitis in people with acute and severe hepatitis to be less than 7% and in people with reported chronic hepatitis between 1% and 34%. The minimum required sample size was calculated as 209 using the prevalence formula. alfa = 0.05 Z1-a/2 = 1.961150826 d = 0.03 p = 0.07 n = 209 $$n=\frac{{Z}_{1-\frac{\alpha }{2}pq}^{2}}{{d}^{2}}$$ 2.1.Exclusion criteria Patients with positive serology for viral hepatitis A, B, and C, drug hepatitis and alcoholic hepatitis and history of the fatty liver based on the clinical history and paraclinical findings and Unwillingness of patients to participate in the study. To avoid bias, all the experiments related to this research were done with one kit and by a specific person. One of the things that can be considered as bias in this research is the presence of unknown non-hepatic autoimmune diseases that interfere with the results of electrophoresis. 3. Results In this study, the serological findings of 209 patients with non-viral hepatitis referring to the internal clinic were evaluated. The mean (standard deviation) age of the patient with non-viral hepatitis participating in the present study was 37.98 years (14.5). Among 209 patients, 56.9% were female and the remaining 43.1% were male. Most patients were 31–40 years (28.1%) and 21–30 years old (25.2%) and the lowest number of patients was in the age group of 70 years (2.4%) (Table 2 ) (Fig. 1 ). Table 2 Frequency of age group in patients with non-viral hepatitis referring to the Hamadan internal clinic in 2019 Age category frequency percent 10–20 19 9 21–30 53 25.2 31–40 59 28.1 41–50 36 17.1 51–60 27 12.9 61–70 10 4.8 > 70 5 2.4 Total 209 100 According to the epidemiological studies on autoimmune hepatitis, it seems that patients with this complication in our country are similar in age and sex to studies in other countries ( 8 , 9 ). However, other studies have been performed on children at younger ages ( 10 – 11 ). In terms of ANA- positive serology, 17.2% of patients had positive serology and the remaining 82.8% had negative serology. Regarding ANA-positive serology, in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 24.8% had positive serology and the remaining 75.2% had negative serology. As shown in Table 3 , the prevalence of ANA -positive serology in non-viral hepatitis cases with hypergammaglobulinemia was higher than those without hypergammaglobulinemia, which was significantly based on the Chi-square test results (p = 0.005). Regarding ASMA-positive serology, 16.3% of patients had positive serology and the remaining 83.7% had negative serology. Regarding ASMA-positive serology in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 23.81% of patients had positive serology and the remaining 76.19% had negative serology. The prevalence of ASMA -positive serology as shown in Table 4 was higher in non-viral hepatitis patients with hypergammaglobulinemia than those without hypergammaglobulinemia. According to the Chi-square test results, this difference was statistically significant. (P = 0.003). Regarding positive-LKM serology in patients with non-viral hepatitis, 1.9% of patients had LKM-positive and others had 98.1% negative serology. Regarding LKM-positive serology in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 3.8% of patients had LKM-positive and 96.2% had negative serology. As shown in Table 5 , the prevalence of LKM-positive serology in people with non-viral hepatitis with hypergammaglobulinemia was higher than those without hypergammaglobulinemia, but according to the Chi-square test results, this difference was not significant (p = 0.062). Regarding positive serology cases (ANA/ASMA/LKM ) in patients with non-viral hepatitis, 28.7% of patients had positive serology and the remaining 71.3% had negative serology. Regarding positive serology ( ANA/ASMA/LKM ) in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 40% had positive serology and the remaining 60% had negative serology. The prevalence of positive serology ( ANA/ASMA/LKM ) in the people with non-viral hepatitis with hypergammaglobulinemia was higher than those without hypergammaglobulinemia, and based on the Chi-square test results, this difference was significant (p = 0.001) (Table 3 ) Table 3. Comparison of the prevalence of ANA-positive cases in individuals with and without polyclonal hypergammaglobulinemia in non-viral hepatitis, Comparison of the prevalence of ASMA positive serology in individuals with and without polyclonal hypergammaglobulinemia in non-viral hepatitis. Comparison of the prevalence of LKM positive serology in individuals with and without hypergammaglobulinemia in non-viral hepatitis, Comparison of the prevalence of positive antibody ( ANA or ASMA or LKM ) in patients with and without hypergammaglobulinemia in non-viral hepatitis Serology status Blood globulin protein levels P-value Hypergammaglobulinemi a No hypergammaglobulinemia Positive LKM 4(3.8%) 0(0%) 0.062 Negative LKM 101(96.2%) 104(100%) total 105(100%) 104(100%) Positive ANA 26(24.48%) 10(9.6%) 0.005 Negative ANA 36(75.2%) 94(90.4%) total 105(100%) 104(100%) Positive ASMA 25(23.8%) 9(8.7%) 0.003 Negative ASMA 80(76.2%) 95(91.3%) Total 105(100%) 104(100%) Positive serology (ANA/ASMA/LKM) 42(40%) 18(17.3%) 0.001 Negative serology (ANA/ASMA/LKM) 63(60%) 86(82.7%) Total 105(100%) 104(100%) According to the results of the Chi-square test, patients with non-viral hepatitis with low albumin (alpha 1 or low alpha 2) and high gamma globulin protein levels were significantly different in terms of positive serology (ANA/ASMA/LKM) compared to patients who did not have this feature (P = 0.004), which indicates the significantly higher prevalence of positive serology of common antibodies in people with electrophoretic patterns in favor of liver failure compared to those without this pattern in patients with non-viral hepatitis. According to the Chi-square test results, patients with non-viral hepatitis with high gamma globulin protein levels (alpha 1 or alpha 2) were not significantly different from serologically positive patients ( ANA/ASMA/LKM ) (p=0.090). In other words, the positive prevalence of common antibodies in people with non-viral hepatitis with an electrophoretic pattern in favor of chronic active hepatitis was higher in patients with non-viral hepatitis than in those without this pattern, but this difference was not significant. According to the results of the Chi-square test, patients with non-viral hepatitis with low albumin (alpha 1 or alpha 2) and high gamma globulin protein levels had no statistically significant difference with patients with this characteristic (ANA/ASMA/LKM ) (p=0.200). The positive prevalence of common antibodies in patients with non-viral hepatitis with electrophoretic patterns in favor of chronic hepatitis was higher than in non-viral hepatitis patients without this pattern, but this difference was not significant (Table 4). Table 4. Comparison of the prevalence of positive antibody (ANA or ASMA or LKM ) in patients with non-viral hepatitis with the electrophoretic pattern including low albumin and low alpha1 or alpha 2 and high gamma compared to patients without this pattern, Comparison of the prevalence of positive antibody (ANA or ASMA or LKM) in patients with non-viral hepatitis with the electrophoretic pattern including high alpha 1 or alpha 2 and high gamma compared to patients without this pattern, Comparison of the prevalence of positive antibody (ANA or ASMA or LKM) in patients with non-viral hepatitis with the electrophoretic pattern including low alpha 1 or alpha 2 and high gamma compared to patients without this pattern Serologic status Low albumin (l ow alpha 1 or low alpha 2 ) and high gammaglobulin protein levels P-value Low albumin ( Alpha 1 or Alpha 2) High and high g ammaglobulin protein levels P-value Low albumin ( Alpha 1 or alpha 2 ) and gammglobulin protein levels P-value Yes No yes No yes No Positive serology (ANA/ASMA/LKM) 11(61.1%) 49(25.7%) 0.004 17(39.5%) 43(25.9%) 0.090 12(38.7%) 48(27%) 0.200 Negative serology ((ANA/ASMA/LKM) 7(38.9%) 142(74.3%) 26(60.5%) 123(74.1%) 19(61.3%) 130(73%) Total 18(100%) 191(100%) 43(100%) 166(100%) 31(100%) 178(100%) According to Table 5, the prevalence of positive serology ( ANA/ASMA/LKM) in cases with non-viral hepatitis increases with an increasing score in the diagnostic scoring system, and this increase is statistically significant according to the Chi-square test results (p =0.001). Table 5. Comparison of the prevalence of positive antibody ( ANA or ASMA or LKM ) with diagnostic scoring system scoring in patients with non-viral hepatitis Diagnostic score Positive serology ( ANA/ASMA/LKM ) Total Yes No 2 8(8.5%) 86(91.5%) 94(100%) 3 8(20%) 32(80%) 40(100%) 4 17(35.4%) 31(64.6%) 48(100%) 5 15(100%) 0 15(100%) 6 12(100%) 0 12(100%) P-value 0.001 209 4. Discussion This study investigated the serological findings of 209 patients with non-viral hepatitis who were referred to the internal clinic. The mean age of the patients with non-viral hepatitis who participated in the study was 37.98 years (SD = 14.5), with 56.9% being women and 43.1% being men. Most of the patients were in the age group of 31–40 years (28%) and 21–30 years (25%), while the least number of patients were in the age group of 70 years (2.4%).According to previous epidemiological studies on autoimmune hepatitis disease( 8 , 9 ), it appears that the patients with this condition in our country are similar to those in other countries in terms of age and gender( 10 , 11 ). However, other studies have focused on children in younger age groups.The results of this study showed that in 209 patients with non-viral hepatitis suspected to be autoimmune hepatitis, 50.2% had hypergammaglobulinemia, 17.2% were ANA positive, 16.3% were ASMA positive, 1.9% were LKM positive, and 28.7% had at least one positive antibody among the common antibodies (ANA-ASMA-LKM ). Furthermore, in 105 patients with non-viral hepatitis and hypergammaglobulinemia suspected to be autoimmune hepatitis, 24.8% were ANA positive, 23.8% were ASMA positive, and 8.3% were LKM positive. Additionally, 40% of patients had at least one positive antibody among the common antibodies (ANA-ASMA-LKM). The prevalence of positive serology of antibodies in people with polyclonal hypergammaglobulinemia was significantly higher than those without polyclonal hypergammaglobulinemia, except for Anti-LKM . However, due to the small number of positive cases, LKM positivity was not statistically significant.A study conducted by Liang et al. in 2018 examined patients with autoimmune hepatitis in terms of serological results of antibodies related to autoimmune hepatitis( 12 ). The results of their study showed that 76.7% of ANA patients and 67% of ASMA patients were positive, and the average blood gamma globulins of the patients were higher than the normal range. The difference between the results of Liang's study and the present study may be due to the examination of patients diagnosed with autoimmune hepatitis, while in the present study, patients with non-viral hepatitis suspected of autoimmune hepatitis were examined( 12 ).In a study carried out by Aghazadeh et al. in 2003, they examined the epidemiological indicators and the response to treatment of autoimmune hepatitis in Taleghani Hospital in Iran( 8 ). The results showed that the prevalence of positive cases of autoantibodies ( ASMA ) and ANA in patients were 54.8% and 38%, respectively. The results of this study were similar to the results of the present study, and the higher rate of antibody positivity in Aghazadeh's study may be due to the examination of antibodies in patients with a definitive diagnosis of autoimmune hepatitis( 8 ). In their 2000 study, Dariani et al. evaluated the epidemiological indicators of autoimmune hepatitis patients in Imam Khomeini Hospital in Iran. They found that 43.6% of patients were positive for ASMA , and 35.9% were positive for ANA ( 13 ). Unlike the present study, they found a higher prevalence of positive ASMA than positive ANA . In 2008, Stefan Luth and colleagues examined the serological markers of autoimmune hepatitis patients ( 14 ). They found that ASMA and ANA were equally positive in 43% of patients. Both markers were simultaneously positive in 21% of patients, while only 1% of patients had positive LKM . Hypergammaglobulinemia was found to be a useful diagnostic criterion for autoimmune hepatitis in this study ( 14 ). While Luth's study found more ANA and ASMA positive cases than the present study, it showed a low prevalence of LKM and a high prevalence of hypergammaglobinemia, similar to the present study. In 2009, Muratori et al. found that 75% of patients with autoimmune hepatitis type 1 were ASMA positive, 63% were ANA positive, and none were positive for LKM. Several studies have indicated a low prevalence of LKM in autoimmune hepatitis patients ( 15 ). The present study differs from Muratori's study in terms of diagnostic certainty. Somroo et al. investigated the serological status of children with autoimmune hepatitis in 2018. They found that all patients had hypergammaglobulinemia, and 55% of patients had positive ANA ( 16 ). The difference between Somroo's study and the present study is likely due to age and diagnostic differences. In 2017, Taubert et al. reported high levels of ASMA and ANA in autoimmune hepatitis patients and considered hypergammaglobulinemia a predictor of treatment status and a diagnostic factor for the disease ( 17 ).The present study found differences in serological criteria compared to other studies, including lower percentages of positive cases of ANA and ASMA in Iran than in other countries. This difference may be due to differences in laboratory methods or racial differences.In addition to hypergammaglobulinemia, the present study found a higher prevalence of positive serology in people with electrophoresis patterns indicative of chronic liver inflammation and liver inflammation leading to liver failure than in those without these patterns. However, this difference was significant only in the group with liver inflammation leading to liver failure.The study also found that the prevalence of positive serology in people with non-viral hepatitis increased with an increase in the score in the scoring system designed to diagnose autoimmune hepatitis, which was statistically significant. All subjects had non-viral hepatitis and received at least 2 points from the scoring system, with 50% also having polyclonal hypergammaglobulinemia, which earned them an additional point. The lack of liver biopsy results resulted in a loss of 2 points for all subjects. In the group with possible and close to probable scores, all patients had positive serology, indicating a probable or definitive diagnosis of autoimmune hepatitis. The possibility of suppressed common antibodies and the delayed appearance of common antibodies should be considered, and over time, serological tests should be repeated. In addition, the possibility of unknown antibodies should also be considered, and biopsy should be performed to add points for people with scores of 4 and 5. The measurement of uncommon serological markers may also improve the diagnostic score and determine the patient's assignment. The prevalence of antibody-negative autoimmune hepatitis in previous studies has been reported between 1 and 34%, with an average of 20% ( 3 , 4 ). 5. Conclusion Our findings indicated the importance of hypergammaglobulinemia and positive serology of at least one of the three common antibodies, including ANA, ASMA , and LKM in people with suspected non-viral hepatitis and autoimmune hepatitis for diagnosis because 40% of suspected patients had serological hypergammaglobulinemia. Positive, common antibodies ( ANA/ASMA/LKM ) were observed, and in line with most studies, the prevalence of ANA-positive serology was higher than ASMA and LKM-positive serology. Despite the difference in our study population’s certainty in diagnosis compared to other studies, the prevalence of autoimmune antibody-negative hepatitis in probable and near probable individuals was zero. Serology of uncommon antibodies was strongly felt in low-scoring cases to determine patients' tasks, as 94% of people suspected of having autoimmune hepatitis remained undecided in this cross-sectional study. These findings can provide basic information for future studies and are effective in localizing external guidelines for the diagnosis of autoimmune hepatitis. Limitation The patient's non-cooperation and giving false information, which seems to have been solved by justifying them and not disclosing the information related to the patients. Declarations Ethics approval and consent to participate: This study was approved by the Research Ethics Committees of the Hamadan University of Medical Science with the ethics code: IR.UMSHA.REC.1398.455. Informed consent was obtained from all participating patients/their legal guardians in this study after fully explaining the study method, the study was fully explained to the patients, and the questions and doubts of the patients were fully answered. It was also explained to the patients that for any reason, they wanted to continue participating in the study. do not have, they can withdraw, and this study will not interfere with their treatment. Also, all patients are assured that all their information is confidential and that only the collective information of the entire investigation is available. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials All data generated or analyzed during this study are included in this published article. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding: The funding source of this research is Hamadan University of Medical Sciences. Authors' contributions: Study concept and design: Hamid Reza Ghasemi Basir. Data acquisition: Alireza Khalilian. Data analysis and interpretation: Hamid Reza Ghasemi Basir. Drafting of the manuscript; critical revision of the manuscript for important intellectual content: Anahita Eslami-Ghayour. Scientific advisor: Mehdi Ghobakhlou Acknowledgements: We thank all the people who have helped us in this way Author information Hamid Reza Ghasemi Basir, MD, Associate Professor of Pathology ,Department of Pathology, School of Medicine,Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran Alireza Khalilian , MD, Assistant Professor of Gastroenterology and Hepatology ,Department of Internal Medicine, School of Medicine, Shahid Beheshti Medical Educational Center, Hamadan University of Medical Sciences, Hamadan, Iran Anahita Eslami-Ghayour, MD, corresponding author' 3 , ( [email protected] ) Mehdi Ghobakhlou,MD, Assistant Professor of Gastroenterology and Hepatology 4 ( [email protected] ) References Johnson PJ, McFarlane IG, Convenors OBotP. Meeting report: international autoimmune hepatitis group. Hepatology. 1993;18(4):998-1005. Manns MP, Lohse AW, Vergani D. Autoimmune hepatitis–update 2015. 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Ebrahimi Daryani N, Mir momen SH,Bahrami H, Mohammadi H, Evaluation epidemiologic factors in Autoimmune hepatitis patients and their response to treatment in Emam Khomaini Hospital.2000;5(29-30) Lüth S, Herkel J, Kanzler S, Frenzel C, Galle PR, Dienes HP, et al. Serologic markers compared with liver biopsy for monitoring disease activity in autoimmune hepatitis. Journal of clinical gastroenterology. 2008;42(8):926-30 Muratori P, Granito A, Pappas G, Pendino GM, Quarneti C, Cicola R, et al. The serological profile of the autoimmune hepatitis/primary biliary cirrhosis overlap syndrome. The American journal of gastroenterology. 2009;104(6):1420. Somroo GB, Rai AA, Luck NH, Abbas Z. Clinical presentation of autoimmune hepatitis in Pakistani children. The Pan African medical journal. 2018;30. Taubert R, Hardtke-Wolenski M, Noyan F, Lalanne C, Jonigk D, Schlue J, et al. Hyperferritinemia and hypergammaglobulinemia predict the treatment response to standard therapy in autoimmune hepatitis. PloS one. 2017;12(6):e0179074-e. Hennes EM, Zeniya M, Czaja AJ, Parés A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-76. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4300149","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":294504428,"identity":"a2a0dc08-35fb-43ed-98e9-cdb667bf3b9d","order_by":0,"name":"Hamid Reza Ghasemi Basir","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hamid","middleName":"Reza Ghasemi","lastName":"Basir","suffix":""},{"id":294504429,"identity":"d0725ca8-afdc-4401-be02-d93dafdeaa3b","order_by":1,"name":"Alireza Khalilian","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Khalilian","suffix":""},{"id":294504430,"identity":"ae271268-5c8d-454b-91c7-9e261e31ac2a","order_by":2,"name":"Anahita Eslami-Ghayour","email":"data:image/png;base64,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","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Anahita","middleName":"","lastName":"Eslami-Ghayour","suffix":""},{"id":294504431,"identity":"1adf9db4-0ecc-4452-8973-4357d1bd89b9","order_by":3,"name":"Mehdi Ghobakhlou","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mehdi","middleName":"","lastName":"Ghobakhlou","suffix":""}],"badges":[],"createdAt":"2024-04-21 09:26:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4300149/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4300149/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55538992,"identity":"af3922ef-f8bb-48e4-b110-2b4a7768acd6","added_by":"auto","created_at":"2024-04-29 16:54:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29533,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency distribution of age group in patients with non-viral hepatitis\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4300149/v1/6b3b86332718956cb7198b72.png"},{"id":55723666,"identity":"8ad156fd-fb15-4a1a-96ea-7da1f2731d00","added_by":"auto","created_at":"2024-05-02 09:30:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":554074,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4300149/v1/047e09ae-ba81-4b1c-bede-6a5606434338.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Frequency of serological results of antibodies related to autoimmune hepatitis in Iranian patients with non-viral hepatitis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAutoimmune hepatitis as a chronic inflammatory disease of the liver can occur when the immune system of the body is stimulated against liver cells. Its exact cause is unknown, but genetic and environmental factors seem to work together over time to develop the disease. Autoimmune hepatitis, if left untreated, leads to liver damage or cirrhosis over time, which can eventually lead to liver failure. The presence of circulating autoantibodies as well as elevated serum globulin levels can be observed in this disease. The disease may have an acute onset and progress to chronic hepatitis and even cirrhosis of the liver (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Rejection of viral and medicinal hepatitis and liver biopsy and laboratory findings are the main factors for diagnosing autoimmune hepatitis. One of the characteristic laboratory findings in autoimmune hepatitis is an increase in serum levels of globulins, which are associated with circulating autoantibodies and are of the \u003cem\u003eIgG\u003c/em\u003e type (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAutoimmune hepatitis is classified into two types I and II according to the type of circulating antibodies: type I: \u003cem\u003eANA, ASMA, AAA, anti-SLA / LP, anti-dsDNA and anti-ssDNA or atypical p-ANCA\u003c/em\u003e and rarely \u003cem\u003eAMA\u003c/em\u003e in the form of \u003cem\u003eAIH-PBC\u003c/em\u003e overlap and type II: \u003cem\u003eanti-LKM1 or ALC-1\u003c/em\u003e in the bloodstream, and a titer of 1/80 for \u003cem\u003eanti-LKM1\u003c/em\u003e may be considered positive while a titer greater than 1/20 is positive for \u003cem\u003eANA\u003c/em\u003e and ASMA (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). About 20% of patients with autoimmune hepatitis lack circulating antibodies, including \u003cem\u003eANA, ASMA\u003c/em\u003e, or \u003cem\u003eanti-LKM1\u003c/em\u003e, known as autoantibody negative \u003cem\u003eAIH\u003c/em\u003e or cryptogenic chronic hepatitis. In these patients, the therapeutic response to anti-inflammatory drugs may be the only clinical finding in favor of autoimmune hepatitis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAutoimmune hepatitis is diagnosed based on the rejection of other common diagnoses. According to a guideline by the American Association for the Study of Liver Disease (2010), in a person with increased serum concentrations of hepatic aminotransferases, at least twice the normal maximum after ruling out viral hepatitis, alcoholic liver disease, drug hepatitis, and measuring serum globulins and common antibodies including \u003cem\u003eANA, ASMA, LKM-1, AMA, gamma globin, and serum IgG\u003c/em\u003e is considered in the first stage.\u003c/p\u003e \u003cp\u003eIf common antibodies are negative, other antibodies, includin\u003cem\u003eg ALC-1, SLA/LPAb\u003c/em\u003e, and atypical \u003cem\u003ep-ANCA\u003c/em\u003e, are tested and \u003cem\u003emagnetic resonance cholangiopancreatography (MRCP)\u003c/em\u003e is performed in people with a history of inflammatory bowel disease \u003cem\u003e(IBD)\u003c/em\u003e or increased \u003cem\u003eALK l\u003c/em\u003eevels (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Studies have shown low levels of antibodies in Iran compared to other communities, which has been attributed to different laboratory instruments. Diagnosis and treatment of autoimmune hepatitis patients should be based evidence-based, considering the prevalence of markers and antibodies.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003ePatients who had chronic hepatitis with raised serum transaminase levels for at least 6 months and positive serology for viral hepatitis A, B, and C, and those with a possibility of drug-induced, alcoholic, or fatty liver hepatitis, were evaluated based on their clinical history and paraclinical findings in their follow-up visit after examining the results of the tests. If the diagnosis of viral hepatitis was ruled out, patients were evaluated for a possible diagnosis of autoimmune hepatitis. All patients underwent a biopsy, and histopathologically, they had chronic hepatitis with or without specific changes of autoimmune hepatitis. Electrophoresis of serum proteins to check electrophoretic patterns and polyclonal hypergammaglobulinemia were requested. In addition, 5 cc of venous blood was taken from the patient for serological tests including \u003cem\u003eANA, ASMA\u003c/em\u003e, and \u003cem\u003eLKM\u003c/em\u003e. To standardize the diagnostic process and improve diagnostic accuracy in autoimmune hepatitis (\u003cem\u003eAIH\u003c/em\u003e), a scoring system based on antibody titer, \u003cem\u003eIgG\u003c/em\u003e or gammaglobulin serum level, liver histopathology, and rejection of viral hepatitis was designed(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The system assigned a score of 1 to \u003cem\u003eANA\u003c/em\u003e or \u003cem\u003eASMA\u003c/em\u003e titer of 1/40, and a score of 2 to \u003cem\u003eANA\u003c/em\u003e or \u003cem\u003eASMA\u003c/em\u003e titer of 1/80 or greater than or equal to 1/40 or positive \u003cem\u003eSLA\u003c/em\u003e. A score of 1 was assigned if the level of serum IgG or gammaglobulin was higher than the maximum normal, and a score of 2 if it was more than 1.1 times the maximum normal. A score of 1 was assigned if the liver biopsy was compatible with \u003cem\u003eAIH\u003c/em\u003e, and a score of 2 if it was typical of \u003cem\u003eAIH\u003c/em\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Typical diagnostic findings included interface hepatitis, lymphoplasmacytic infiltration in the portal tract with extension to the hepatic lobule, emperipolesis (active infiltration of a larger intracellular cell), and hepatic rosette formation. Compatible diagnosis findings included chronic hepatitis with lymphocytic infiltration in the absence of all typical findings. The absence of viral hepatitis based on tests related to hepatitis B and C was assigned a score of 2, and other types of viral hepatitis was considered on a case-by-case basis based on clinical findings. A final score of 6 or more indicated a probable or definite diagnosis of autoimmune hepatitis, respectively.The descriptive statistics section included mean and standard deviation for quantitative variables with normal distribution, and frequency and percentage for qualitative variables in the form of frequency distribution tables and graphs. The Chi-square test was used to compare qualitative variables. The data were analyzed using SPSS version 22 software, and a statistical significance level of less than 5% was considered. The study was conducted in the gastroenterology clinic of Shahid Beheshti Medical Training Hospital in Hamadan in 2019. The study population included patients referred to the clinic for follow-up on the cause of liver inflammation, with an increase in the level of liver enzymes \u003cem\u003eAST\u003c/em\u003e and \u003cem\u003eALT\u003c/em\u003e (at least 2 times the maximum normal), after ruling out viral hepatitis, drug-induced, alcoholic, or fatty liver hepatitis. The study sample included 209 patients under investigation for the diagnosis of autoimmune hepatitis. The sample size was calculated based on Czaja et al.'s study in 2012(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), titled \"antibody-negative autoimmune hepatitis,\" which found the prevalence of antibody-negative autoimmune hepatitis in people with acute and severe hepatitis to be less than 7% and in people with reported chronic hepatitis between 1% and 34%. The minimum required sample size was calculated as 209 using the prevalence formula.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ealfa\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eZ1-a/2\u0026thinsp;=\u0026thinsp;1.961150826\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cdiv id=\"Equa\" class=\"Equation\"\u003e \u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$n=\\frac{{Z}_{1-\\frac{\\alpha }{2}pq}^{2}}{{d}^{2}}$$\u003c/div\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1.Exclusion criteria\u003c/h2\u003e \u003cp\u003ePatients with positive serology for viral hepatitis A, B, and C, drug hepatitis and alcoholic hepatitis and history of the fatty liver based on the clinical history and paraclinical findings and Unwillingness of patients to participate in the study. To avoid bias, all the experiments related to this research were done with one kit and by a specific person. One of the things that can be considered as bias in this research is the presence of unknown non-hepatic autoimmune diseases that interfere with the results of electrophoresis.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eIn this study, the serological findings of 209 patients with non-viral hepatitis referring to the internal clinic were evaluated. The mean (standard deviation) age of the patient with non-viral hepatitis participating in the present study was 37.98 years (14.5). Among 209 patients, 56.9% were female and the remaining 43.1% were male. Most patients were 31\u0026ndash;40 years (28.1%) and 21\u0026ndash;30 years old (25.2%) and the lowest number of patients was in the age group of 70 years (2.4%) (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of age group in patients with non-viral hepatitis referring to the Hamadan internal clinic in 2019\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003efrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003epercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to the epidemiological studies on autoimmune hepatitis, it seems that patients with this complication in our country are similar in age and sex to studies in other countries (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). However, other studies have been performed on children at younger ages (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn terms of \u003cem\u003eANA-\u003c/em\u003epositive serology, 17.2% of patients had positive serology and the remaining 82.8% had negative serology. Regarding \u003cem\u003eANA-positive\u003c/em\u003e serology, in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 24.8% had positive serology and the remaining 75.2% had negative serology. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the prevalence of \u003cem\u003eANA\u003c/em\u003e-positive serology in non-viral hepatitis cases with hypergammaglobulinemia was higher than those without hypergammaglobulinemia, which was significantly based on the Chi-square test results (p\u0026thinsp;=\u0026thinsp;0.005). Regarding \u003cem\u003eASMA-positive\u003c/em\u003e serology, 16.3% of patients had positive serology and the remaining 83.7% had negative serology. Regarding \u003cem\u003eASMA-positive\u003c/em\u003e serology in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 23.81% of patients had positive serology and the remaining 76.19% had negative serology. The prevalence of \u003cem\u003eASMA\u003c/em\u003e-positive serology as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e was higher in non-viral hepatitis patients with hypergammaglobulinemia than those without hypergammaglobulinemia. According to the Chi-square test results, this difference was statistically significant. (P\u0026thinsp;=\u0026thinsp;0.003). Regarding \u003cem\u003epositive-LKM\u003c/em\u003e serology in patients with non-viral hepatitis, 1.9% of patients had \u003cem\u003eLKM-positive\u003c/em\u003e and others had 98.1% negative serology. Regarding \u003cem\u003eLKM-positive\u003c/em\u003e serology in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 3.8% of patients had \u003cem\u003eLKM-positive\u003c/em\u003e and 96.2% had negative serology. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the prevalence of \u003cem\u003eLKM-positive\u003c/em\u003e serology in people with non-viral hepatitis with hypergammaglobulinemia was higher than those without hypergammaglobulinemia, but according to the Chi-square test results, this difference was not significant (p\u0026thinsp;=\u0026thinsp;0.062). Regarding positive serology cases \u003cem\u003e(ANA/ASMA/LKM\u003c/em\u003e) in patients with non-viral hepatitis, 28.7% of patients had positive serology and the remaining 71.3% had negative serology. Regarding positive serology (\u003cem\u003eANA/ASMA/LKM\u003c/em\u003e) in patients with non-viral hepatitis with polyclonal hypergammaglobulinemia, 40% had positive serology and the remaining 60% had negative serology. The prevalence of positive serology (\u003cem\u003eANA/ASMA/LKM\u003c/em\u003e) in the people with non-viral hepatitis with hypergammaglobulinemia was higher than those without hypergammaglobulinemia, and based on the Chi-square test results, this difference was significant (p\u0026thinsp;=\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Comparison of the prevalence of \u003cem\u003eANA-positive\u003c/em\u003e cases in individuals with and without polyclonal hypergammaglobulinemia in non-viral hepatitis, Comparison of the prevalence of ASMA positive serology in individuals with and without polyclonal hypergammaglobulinemia in non-viral hepatitis. Comparison of the prevalence of \u003cem\u003eLKM\u0026nbsp;\u003c/em\u003epositive serology in individuals with and without hypergammaglobulinemia in non-viral hepatitis, Comparison of the prevalence of positive antibody (\u003cem\u003eANA or ASMA or LKM\u003c/em\u003e) in patients with and without hypergammaglobulinemia in non-viral hepatitis\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSerology status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood globulin protein levels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eHypergammaglobulinemi\u003c/em\u003ea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo \u003cem\u003ehypergammaglobulinemia\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePositive LKM\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4(3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNegative LKM\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e101(96.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003etotal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePositive ANA\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26(24.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10(9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNegative ANA\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36(75.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94(90.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003etotal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePositive ASMA\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25(23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9(8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNegative ASMA\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e80(76.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95(91.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ePositive serology (ANA/ASMA/LKM)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42(40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18(17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNegative serology (ANA/ASMA/LKM)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e63(60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86(82.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e105(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e104(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the results of the Chi-square test, patients with non-viral hepatitis with low albumin (alpha 1 or low alpha 2) and high gamma globulin protein levels were significantly different in terms of positive serology \u003cem\u003e(ANA/ASMA/LKM)\u003c/em\u003e compared to patients who did not have this feature (P = 0.004), which indicates the significantly higher prevalence of positive serology of common antibodies in people with electrophoretic patterns in favor of liver failure compared to those without this pattern in patients with non-viral hepatitis. According to the Chi-square test results, patients with non-viral hepatitis with high gamma globulin protein levels (alpha 1 or alpha 2) were not significantly different from serologically positive patients (\u003cem\u003eANA/ASMA/LKM\u003c/em\u003e) (p=0.090). In other words, the positive prevalence of common antibodies in people with non-viral hepatitis with an electrophoretic pattern in favor of chronic active hepatitis was higher in patients with non-viral hepatitis than in those without this pattern, but this difference was not significant. According to the results of the Chi-square test, patients with non-viral hepatitis with low albumin (alpha 1 or alpha 2) and high gamma globulin protein levels had no statistically significant difference with patients with this characteristic \u003cem\u003e(ANA/ASMA/LKM\u003c/em\u003e) (p=0.200). The positive prevalence of common antibodies in patients with non-viral hepatitis with electrophoretic patterns in favor of chronic hepatitis was higher than in non-viral hepatitis patients without this pattern, but this difference was not significant (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. \u003c/strong\u003eComparison of the prevalence of positive antibody \u003cem\u003e(ANA or ASMA or LKM\u003c/em\u003e) in patients with non-viral hepatitis with the electrophoretic pattern including low albumin and low \u003cem\u003ealpha1 or alpha 2\u003c/em\u003e and high gamma compared to patients without this pattern, Comparison of the prevalence of positive antibody \u003cem\u003e(ANA or ASMA or LKM)\u003c/em\u003e in patients with non-viral hepatitis with the electrophoretic pattern including high \u003cem\u003ealpha 1 or alpha 2\u003c/em\u003e and high gamma compared to patients without this pattern, Comparison of the prevalence of positive antibody\u003cem\u003e\u0026nbsp;(ANA or ASMA \u0026nbsp;or LKM)\u003c/em\u003e in patients with non-viral hepatitis with the electrophoretic pattern including low\u0026nbsp;\u003cem\u003ealpha 1 \u0026nbsp;or alpha 2\u0026nbsp;\u003c/em\u003eand high gamma compared to patients without this pattern\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.90047393364929%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSerologic status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.274881516587676%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLow albumin (l\u003cem\u003eow alpha 1 or low alpha 2\u003c/em\u003e) and high \u003cem\u003egammaglobulin\u003c/em\u003e protein levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6350710900473935%\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.958925750394943%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLow albumin (\u003cem\u003eAlpha 1 or Alpha 2)\u003c/em\u003e High and high g\u003cem\u003eammaglobulin\u003c/em\u003e protein levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.530805687203792%\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.484992101105846%\" colspan=\"2\"\u003e\n \u003cp\u003eLow albumin (\u003cem\u003eAlpha 1 or alpha 2\u003c/em\u003e) and \u003cem\u003egammglobulin\u003c/em\u003e protein levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.214849921011059%\" rowspan=\"2\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.346153846153847%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.548076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.865384615384615%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.548076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.865384615384615%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.826923076923077%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.90047393364929%\"\u003e\n \u003cp\u003ePositive serology \u003cem\u003e(ANA/ASMA/LKM)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.742496050552923%\"\u003e\n \u003cp\u003e11(61.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.532385466034755%\"\u003e\n \u003cp\u003e49(25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.6350710900473935%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.42654028436019%\"\u003e\n \u003cp\u003e17(39.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.532385466034755%\"\u003e\n \u003cp\u003e43(25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.530805687203792%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.42654028436019%\"\u003e\n \u003cp\u003e12(38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\"\u003e\n \u003cp\u003e48(27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.214849921011059%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.22680412371134%\"\u003e\n \u003cp\u003eNegative serology ((ANA/ASMA/LKM)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.02061855670103%\"\u003e\n \u003cp\u003e7(38.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.051546391752577%\"\u003e\n \u003cp\u003e142(74.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.608247422680412%\"\u003e\n \u003cp\u003e26(60.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.051546391752577%\"\u003e\n \u003cp\u003e123(74.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.608247422680412%\"\u003e\n \u003cp\u003e19(61.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\"\u003e\n \u003cp\u003e130(73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.22680412371134%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.02061855670103%\"\u003e\n \u003cp\u003e18(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.051546391752577%\"\u003e\n \u003cp\u003e191(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.608247422680412%\"\u003e\n \u003cp\u003e43(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.051546391752577%\"\u003e\n \u003cp\u003e166(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.608247422680412%\"\u003e\n \u003cp\u003e31(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.43298969072165%\"\u003e\n \u003cp\u003e178(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to Table 5, the prevalence of positive serology (\u003cem\u003eANA/ASMA/LKM)\u003c/em\u003e in cases with non-viral hepatitis increases with an increasing score in the diagnostic scoring system, and this increase is statistically significant according to the Chi-square test results (p =0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Comparison of the prevalence of positive antibody (\u003cem\u003eANA or ASMA or LKM\u003c/em\u003e) with diagnostic scoring system scoring in patients with non-viral hepatitis\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDiagnostic score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePositive serology (\u003cem\u003eANA/ASMA/LKM\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8(8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86(91.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32(80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17(35.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31(64.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study investigated the serological findings of 209 patients with non-viral hepatitis who were referred to the internal clinic. The mean age of the patients with non-viral hepatitis who participated in the study was 37.98 years (SD\u0026thinsp;=\u0026thinsp;14.5), with 56.9% being women and 43.1% being men. Most of the patients were in the age group of 31\u0026ndash;40 years (28%) and 21\u0026ndash;30 years (25%), while the least number of patients were in the age group of 70 years (2.4%).According to previous epidemiological studies on autoimmune hepatitis disease(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), it appears that the patients with this condition in our country are similar to those in other countries in terms of age and gender(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, other studies have focused on children in younger age groups.The results of this study showed that in 209 patients with non-viral hepatitis suspected to be autoimmune hepatitis, 50.2% had hypergammaglobulinemia, 17.2% were \u003cem\u003eANA\u003c/em\u003e positive, 16.3% were \u003cem\u003eASMA\u003c/em\u003e positive, 1.9% were LKM positive, and 28.7% had at least one positive antibody among the common antibodies \u003cem\u003e(ANA-ASMA-LKM\u003c/em\u003e). Furthermore, in 105 patients with non-viral hepatitis and hypergammaglobulinemia suspected to be autoimmune hepatitis, 24.8% were \u003cem\u003eANA\u003c/em\u003e positive, 23.8% were \u003cem\u003eASMA\u003c/em\u003e positive, and 8.3% were \u003cem\u003eLKM\u003c/em\u003e positive. Additionally, 40% of patients had at least one positive antibody among the common antibodies \u003cem\u003e(ANA-ASMA-LKM).\u003c/em\u003e The prevalence of positive serology of antibodies in people with polyclonal hypergammaglobulinemia was significantly higher than those without polyclonal hypergammaglobulinemia, except for \u003cem\u003eAnti-LKM\u003c/em\u003e. However, due to the small number of positive cases, \u003cem\u003eLKM\u003c/em\u003e positivity was not statistically significant.A study conducted by Liang et al. in 2018 examined patients with autoimmune hepatitis in terms of serological results of antibodies related to autoimmune hepatitis(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The results of their study showed that 76.7% of \u003cem\u003eANA\u003c/em\u003e patients and 67% of \u003cem\u003eASMA\u003c/em\u003e patients were positive, and the average blood gamma globulins of the patients were higher than the normal range. The difference between the results of Liang's study and the present study may be due to the examination of patients diagnosed with autoimmune hepatitis, while in the present study, patients with non-viral hepatitis suspected of autoimmune hepatitis were examined(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).In a study carried out by Aghazadeh et al. in 2003, they examined the epidemiological indicators and the response to treatment of autoimmune hepatitis in Taleghani Hospital in Iran(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The results showed that the prevalence of positive cases of autoantibodies (\u003cem\u003eASMA\u003c/em\u003e) and \u003cem\u003eANA\u003c/em\u003e in patients were 54.8% and 38%, respectively. The results of this study were similar to the results of the present study, and the higher rate of antibody positivity in Aghazadeh's study may be due to the examination of antibodies in patients with a definitive diagnosis of autoimmune hepatitis(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In their 2000 study, Dariani et al. evaluated the epidemiological indicators of autoimmune hepatitis patients in Imam Khomeini Hospital in Iran. They found that 43.6% of patients were positive for \u003cem\u003eASMA\u003c/em\u003e, and 35.9% were positive for \u003cem\u003eANA\u003c/em\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Unlike the present study, they found a higher prevalence of positive \u003cem\u003eASMA\u003c/em\u003e than positive \u003cem\u003eANA\u003c/em\u003e. In 2008, Stefan Luth and colleagues examined the serological markers of autoimmune hepatitis patients (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). They found that ASMA and ANA were equally positive in 43% of patients. Both markers were simultaneously positive in 21% of patients, while only 1% of patients had positive \u003cem\u003eLKM\u003c/em\u003e. Hypergammaglobulinemia was found to be a useful diagnostic criterion for autoimmune hepatitis in this study (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While Luth's study found more \u003cem\u003eANA\u003c/em\u003e and \u003cem\u003eASMA\u003c/em\u003e positive cases than the present study, it showed a low prevalence of \u003cem\u003eLKM\u003c/em\u003e and a high prevalence of hypergammaglobinemia, similar to the present study. In 2009, Muratori et al. found that 75% of patients with autoimmune hepatitis type 1 were \u003cem\u003eASMA\u003c/em\u003e positive, 63% were ANA positive, and none were positive for \u003cem\u003eLKM.\u003c/em\u003e Several studies have indicated a low prevalence of \u003cem\u003eLKM\u003c/em\u003e in autoimmune hepatitis patients (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The present study differs from Muratori's study in terms of diagnostic certainty. Somroo et al. investigated the serological status of children with autoimmune hepatitis in 2018. They found that all patients had hypergammaglobulinemia, and 55% of patients had positive \u003cem\u003eANA\u003c/em\u003e (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The difference between Somroo's study and the present study is likely due to age and diagnostic differences. In 2017, Taubert et al. reported high levels of \u003cem\u003eASMA\u003c/em\u003e and \u003cem\u003eANA\u003c/em\u003e in autoimmune hepatitis patients and considered hypergammaglobulinemia a predictor of treatment status and a diagnostic factor for the disease (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).The present study found differences in serological criteria compared to other studies, including lower percentages of positive cases of \u003cem\u003eANA\u003c/em\u003e and \u003cem\u003eASMA\u003c/em\u003e in Iran than in other countries. This difference may be due to differences in laboratory methods or racial differences.In addition to hypergammaglobulinemia, the present study found a higher prevalence of positive serology in people with electrophoresis patterns indicative of chronic liver inflammation and liver inflammation leading to liver failure than in those without these patterns. However, this difference was significant only in the group with liver inflammation leading to liver failure.The study also found that the prevalence of positive serology in people with non-viral hepatitis increased with an increase in the score in the scoring system designed to diagnose autoimmune hepatitis, which was statistically significant. All subjects had non-viral hepatitis and received at least 2 points from the scoring system, with 50% also having polyclonal hypergammaglobulinemia, which earned them an additional point. The lack of liver biopsy results resulted in a loss of 2 points for all subjects. In the group with possible and close to probable scores, all patients had positive serology, indicating a probable or definitive diagnosis of autoimmune hepatitis. The possibility of suppressed common antibodies and the delayed appearance of common antibodies should be considered, and over time, serological tests should be repeated. In addition, the possibility of unknown antibodies should also be considered, and biopsy should be performed to add points for people with scores of 4 and 5. The measurement of uncommon serological markers may also improve the diagnostic score and determine the patient's assignment. The prevalence of antibody-negative autoimmune hepatitis in previous studies has been reported between 1 and 34%, with an average of 20% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur findings indicated the importance of hypergammaglobulinemia and positive serology of at least one of the three common antibodies, including \u003cem\u003eANA, ASMA\u003c/em\u003e, and \u003cem\u003eLKM\u003c/em\u003e in people with suspected non-viral hepatitis and autoimmune hepatitis for diagnosis because 40% of suspected patients had serological hypergammaglobulinemia. Positive, common antibodies (\u003cem\u003eANA/ASMA/LKM\u003c/em\u003e) were observed, and in line with most studies, the prevalence of \u003cem\u003eANA-positive\u003c/em\u003e serology was higher than \u003cem\u003eASMA\u003c/em\u003e and \u003cem\u003eLKM-positive\u003c/em\u003e serology. Despite the difference in our study population\u0026rsquo;s certainty in diagnosis compared to other studies, the prevalence of autoimmune antibody-negative hepatitis in probable and near probable individuals was zero. Serology of uncommon antibodies was strongly felt in low-scoring cases to determine patients' tasks, as 94% of people suspected of having autoimmune hepatitis remained undecided in this cross-sectional study. These findings can provide basic information for future studies and are effective in localizing external guidelines for the diagnosis of autoimmune hepatitis.\u003c/p\u003e"},{"header":"Limitation","content":"\u003cp\u003eThe patient\u0026apos;s non-cooperation and giving false information, which seems to have been solved by justifying them and not disclosing the information related to the patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committees of the Hamadan University of Medical Science with the ethics code: IR.UMSHA.REC.1398.455. Informed consent was obtained from all participating patients/their legal guardians in this study after fully explaining the study method, the study was fully explained to the patients, and the questions and doubts of the patients were fully answered. It was also explained to the patients that for any reason, they wanted to continue participating in the study. do not have, they can withdraw, and this study will not interfere with their treatment. Also, all patients are assured that all their information is confidential and that only the collective information of the entire investigation is available. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funding source of this research is Hamadan University of Medical Sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design: Hamid Reza Ghasemi Basir.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData acquisition: Alireza Khalilian. Data analysis and interpretation: Hamid Reza Ghasemi Basir.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDrafting of the manuscript; critical revision of the manuscript for important intellectual content: Anahita Eslami-Ghayour.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eScientific advisor: Mehdi Ghobakhlou\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the people who have helped us in this way\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHamid Reza Ghasemi Basir, MD,\u0026nbsp;Associate Professor of Pathology\u003csup\u003e\u0026nbsp;\u003c/sup\u003e ,Department of Pathology, School of Medicine,Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical Sciences, Hamadan, Iran\u003c/p\u003e\n\u003cp\u003eAlireza Khalilian , MD, Assistant Professor of Gastroenterology and Hepatology \u0026nbsp;,Department of Internal Medicine, School of Medicine, Shahid Beheshti Medical Educational Center, Hamadan University of Medical Sciences, Hamadan, Iran\u003c/p\u003e\n\u003cp\u003eAnahita Eslami-Ghayour, MD, corresponding author\u0026apos; \u003csup\u003e3\u003c/sup\u003e, ([email protected] )\u003c/p\u003e\n\u003cp\u003eMehdi Ghobakhlou,MD, Assistant Professor of Gastroenterology and Hepatology \u003cem\u003e\u003csup\u003e4 (\u003c/sup\u003e\u003c/em\[email protected])\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJohnson PJ, McFarlane IG, Convenors OBotP. Meeting report: international autoimmune hepatitis group. Hepatology. 1993;18(4):998-1005.\u003c/li\u003e\n\u003cli\u003eManns MP, Lohse AW, Vergani D. Autoimmune hepatitis\u0026ndash;update 2015. Journal of hepatology. 2015;62(1):S100-S11.\u003c/li\u003e\n\u003cli\u003eCzaja AJ. Autoantibody-negative autoimmune hepatitis. Digestive diseases and sciences. 2012;57(3):610-24.\u003c/li\u003e\n\u003cli\u003eHeneghan MA, Yeoman AD, Verma S, Smith AD, Longhi MS. Autoimmune hepatitis. The Lancet. 2013;382(9902):1433-44.\u003c/li\u003e\n\u003cli\u003eBinicier \u0026Ouml;B, G\u0026uuml;nay S. The efficacy and adverse effects of budesonide in remission induction treatment of autoimmune hepatitis: a retrospective study. Croatian medical journal. 2019;60(4):345.\u003c/li\u003e\n\u003cli\u003eFrenzel C, Herkel J, L\u0026uuml;th S, Galle PR, Schramm C, Lohse AW. Evaluation of F-actin ELISA for the diagnosis of autoimmune hepatitis. The American journal of gastroenterology. 2006;101(12):2731.\u003c/li\u003e\n\u003cli\u003e. Hennes EM, Zeniya M, Czaja AJ, Par\u0026eacute;s A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-76.\u003c/li\u003e\n\u003cli\u003eEpidemiological indices of 31 patients with autoimmune hepatitis and their response to treatment. Pejouhesh dar Pezeshki (Research in Medicine). 2003;27(1):53-6.\u003c/li\u003e\n\u003cli\u003eOthman AM, Hamzah EA, Almughales JA, Al-Mikhlafy A. SERUM POSITIVITY OF ANA AND ASMA AMONG KHAT AND NONKHAT CHEWERS AS MARKERS FOR AUTOIMMUNE HEPATITIS TYPE. Universal J Pharm Res. 2017;2(4):20-4.\u003c/li\u003e\n\u003cli\u003eFarid E, M Isa H, Al Nasef M, Mohamed R, Jamsheer H. Childhood autoimmune hepatitis in Bahrain: a tertiary center experience. Iranian Journal of Immunology. 2015;12(2):141-8.\u003c/li\u003e\n\u003cli\u003eKarakoyun M, Ecevit CO, Kilicoglu E, Aydogdu S, Yagci RV, Ozgenc F. Autoimmune hepatitis and long-term disease course in children in Turkey, a single-center experience. European journal of gastroenterology \u0026amp; hepatology. 2016;28(8):927-30.\u003c/li\u003e\n\u003cli\u003eLiang M, Liwen Z, Yun Z, Yanbo D, Jianping C. Serum levels of IL-33 and correlation with IL-4, IL-17A, and hypergammaglobulinemia in patients with autoimmune hepatitis. Mediators of inflammation. 2018;2018.\u003c/li\u003e\n\u003cli\u003eEbrahimi Daryani N, Mir momen SH,Bahrami H, Mohammadi H, Evaluation epidemiologic factors in Autoimmune hepatitis patients and their response to treatment in Emam Khomaini Hospital.2000;5(29-30)\u003c/li\u003e\n\u003cli\u003eL\u0026uuml;th S, Herkel J, Kanzler S, Frenzel C, Galle PR, Dienes HP, et al. Serologic markers compared with liver biopsy for monitoring disease activity in autoimmune hepatitis. Journal of clinical gastroenterology. 2008;42(8):926-30\u003c/li\u003e\n\u003cli\u003eMuratori P, Granito A, Pappas G, Pendino GM, Quarneti C, Cicola R, et al. The serological profile of the autoimmune hepatitis/primary biliary cirrhosis overlap syndrome. The American journal of gastroenterology. 2009;104(6):1420.\u003c/li\u003e\n\u003cli\u003eSomroo GB, Rai AA, Luck NH, Abbas Z. Clinical presentation of autoimmune hepatitis in Pakistani children. The Pan African medical journal. 2018;30.\u003c/li\u003e\n\u003cli\u003eTaubert R, Hardtke-Wolenski M, Noyan F, Lalanne C, Jonigk D, Schlue J, et al. Hyperferritinemia and hypergammaglobulinemia predict the treatment response to standard therapy in autoimmune hepatitis. PloS one. 2017;12(6):e0179074-e.\u003c/li\u003e\n\u003cli\u003eHennes EM, Zeniya M, Czaja AJ, Par\u0026eacute;s A, Dalekos GN, Krawitt EL, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008;48(1):169-76.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Serology, Autoimmune hepatitis, Epidemiology, Antibody","lastPublishedDoi":"10.21203/rs.3.rs-4300149/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4300149/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAutoimmune hepatitis as a chronic inflammatory disease of the liver can occur when the body's immune system is stimulated against liver cells, but its exact cause is unknown. Autoimmune hepatitis, if left untreated, leads to liver damage or cirrhosis over time, which can eventually cause liver failure.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003e This descriptive-analytical study was done to assess the frequency of serological results of autoimmune hepatitis-related antibodies in patients with non-viral hepatitis referring to an inpatient clinic in 2019 and provide basic information for future studies and assistance in localization of external guidelines performed to diagnose autoimmune hepatitis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAll patients were evaluated for age and sex, \u003cem\u003eANA, ASMA, and LKM antibodies\u003c/em\u003e, and immunoglobulin by preparing 5 cc of blood samples using laboratory techniques and electrophoresis. The collected data were recorded in the checklist created by the researcher.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe total number of 209 patients with non-viral hepatitis, with a mean age of 37.98 years participated in this study. In patients with non-viral hepatitis, 50.2% of patients had polyclonal \u003cem\u003ehypergammaglobulinemia\u003c/em\u003e, in 17.2% \u003cem\u003eANA\u003c/em\u003e was positive, in 16.3% \u003cem\u003eASMA\u003c/em\u003e was positive, and 1.9% \u003cem\u003eLKM\u003c/em\u003e was positive.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ehypergammaglobulinemia, \u003cem\u003eANA, and ASMA\u003c/em\u003e are suitable antibodies for autoimmune hepatitis. Moreover, laboratory results of \u003cem\u003eANA and ASMA\u003c/em\u003e in patients with autoimmune hepatitis indicate low levels of these antibodies in Iran and their deficiency in other countries. Conventional diagnostic methods can provide a definitive diagnosis. Therefore, it shows the need for further examination of laboratory instruments and wider use of other diagnostic methods, including biopsy and further assessments.\u003c/p\u003e","manuscriptTitle":"Frequency of serological results of antibodies related to autoimmune hepatitis in Iranian patients with non-viral hepatitis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 16:53:56","doi":"10.21203/rs.3.rs-4300149/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8bfbd82c-7333-4aa3-98e8-979a02d8f9cc","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-02T09:30:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 16:53:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4300149","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4300149","identity":"rs-4300149","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}