Abstract: Objective The aim of this study was to investigate implication of serum albumin/alkaline phosphatase ratio (AAPR) , leukocyte-derived chemokine 2 (LECT2) and interleukin-21 (IL-21) levels in patients with autoimmune hepatitis (AIH). Methods 58 patients with AIH were encountered in our hospital between May 2023 and May 2025, and all received standardized first-line treatment regimen, e.g., prednisone and azathioprine combination. Serum LECT2 and IL-21 levels were assayed by ELISA, and laboratory tests were obtained and AAPR was calculated. A binary Logistic regression model was constructed to analyze the risk factors influencing response to treatment, and receiver operating characteristic curve (ROC) was applied toevaluate predicting efficacy. Results By end of six month treatment, 35 patients(60.3%) obtained complete response (CR) and 23 patients(39.7%)didn’t; serum LECT2, IL-21 and IgG levels in patients with non-CR (NCR) were (28.5±5.3)ng/mL, (263.5±25.6)pg/mL and (29.7±2.4) g/L, all much higher than [((20.4±4.1)ng/mL, (174.5±21.9)pg/mL and (23.1±2.1)g/L, respectively, P<0.05], while AAPR was (0.3±0.1), much lower than [(0.4±0.1), P<0.05] in those with CR; binary Logistic regression analysis showed that AAPR, serum IgG, LECT2 and IL-21 levels were all the independent risk factors for incomplete response to immunosuppressive therapy(P<0.05); ROC analysis demonstrated that the AUC was 0.891, with relatively low sensitivity of 73.1%, but a relatively high specificity of 97.1%, when serum IgG level was combined with any two of serum AAPR, LECT2 or IL-21 levels in predicting response to immunosuppressive treatment. Conclusion Surveillance of serum AAPR, LECT2 and IL-21 level changes might help clinicians predict response to immunosuppressive therapy in patients with AIH, which warrants further clinical investigation.

Key words: Autoimmune hepatitis, Immunosuppressive therapy, Albumin, Alkaline phosphatase, Leukocyte-derived chemokine 2, Interleukin-21, Therapy