Evaluation of autoimmune phenomena in patients with nonalcoholic fatty liver disease on the basis of liver pathology

Background: Autoimmune phenomena can be used in some patients with nonalcoholic fatty liver disease (NAFLD) in the clinic, but these patients are not autoimmune hepatitis patients.

Aim: To determine whether autoimmunity is present in patients with NAFLD, this study was performed.

Methods: A total of 104 patients with NAFLD diagnosed by liver biopsy at Tianjin Second People's Hospital between 2019 and 2023 were enrolled. The patients were divided into three groups according to their biopsy results: The NAFL (n = 36), nonalcoholic steatohepatitis (n = 51), and liver cirrhosis groups (n = 17).

Results: The differences in IgA, an immune marker, among the three groups of patients were statistically significant (P = 0.025). In all NAFLD patients, antinuclear antibody and anti-smooth muscle antibody were the most common autoantibodies. The antinuclear antibody detection rate was the highest at 48.1%. The cirrhosis group had the highest autoantibody positivity rate (64.7%). Portal enlargement is also common in NAFLD patients. The rates of positivity for portal lymphoplasmacytic infiltration, small bile duct hyperplasia and interfacial hepatitis were highest in the cirrhosis group; the differences between the cirrhosis group and the other two groups were significant (P < 0.05). Hepatocellular rosettes were identified only in the cirrhosis group (11.8%).

Conclusion: Autoimmune phenomena occur in NAFLD patients, especially in patients with NAFLD-related cirrhosis, in whom this phenomenon may be more pronounced.