Abstract: Objective This study was conducted to explore the impact of hepatic steatosis on biochemical remission in patients with autoimmune hepatitis (AIH) receiving standardized prednisone and azathioprine therapy. Methods 58 patients with AIH were encountered in our hospital between January 2018 and December 2022, and all received standardized prednisone and azathioprine therapy for six months. At admission, all patients underwent liver biopsies, and the controlled attenuation parameter (CAP) and liver stiffness measurement were detected by FibroScan 502. The therapeutic efficacy was assessed as complete remission (CR) and insufficient biochemical remission (IBR). The influencing factors on biochemical remission and untoward outcomes were analyzed by multivariate Logistic regression. Results At the end of six month treatment, 35 patients (60.3%) responded, while 23 patients (39.7%) didn't; the body mass index, the percentages of concomitant hypertension and diabetes, serum globulin level as well as the CAP and LSM in patients with IBR were (26.9±2.8)kg/m², 43.5% and 39.1%, 34.6(28.4, 38.4)g/L, and (275.6±16.5)dB/m and 9.8(6.5, 13.6) kPa, all significantly higher than [(22.1±2.8)kg/m², 11.4% and 5.7%, 25.3(23.6, 29.4)g/L, and (192.0±33.5)dB/m and 5.4(2.5, 8.0)kPa, respectively, P<0.05], while serum albumin level was 32.4(31.6, 35.7)g/L, much lower than [38.3(33.6, 43.7)g/L, P<0.05] in patients with CR; the multivariate Logistic regression analysis showed that the CAP, severe hepatic steatosis and the LSM were all the independent risk factors for the occurrence of IBR and untoward outcomes (P<0.05) in patients with AIH. Conclusion The hepatic steatosis could impact the response to standardized therapy in patients with AIH, which might lead to the untoward outcomes and needs carefully managed in clinical practice.

Key words: Autoimmune hepatitis, Prednisone, Azathioprine, Hepatic steatosis, Therapy, Insufficient biochemical remission