伴有自身免疫现象的药物性肝损伤患者临床特征分析*

doi:10.3969/j.issn.1672-5069.2025.03.018

摘要/Abstract

摘要： 目的分析总结伴有自身免疫现象的药物性肝损伤(DILI)患者的临床特点,以及应用免疫抑制剂治疗后的病情转归,为临床诊治提供参考意见。方法 2018年1月～2023年1月首都医科大学附属北京地坛医院住院治疗的DILI患者312例,常规行肝活检,对伴有自身免疫现象的患者,给予免疫抑制剂治疗。结果对停药后肝损伤持续、血清球蛋白水平升高和自身抗体阳性者被诊断为伴有自身免疫现象的DILI患者73例和DILI患者239例;伴有自身免疫现象的DILI组口服中草药占比显著高于DILI组(P＜0.05),血清胆碱酯酶水平显著低于,而血清总胆汁酸、胆红素、球蛋白和IgG水平显著高于DILI组(P＜0.05);伴有自身免疫现象的DILI患者肝组织损伤更加明显;70例伴有自身免疫的DILI患者接受了免疫抑制剂治疗,在治疗3个月后,疾病缓解率为48.6%,不完全应答率为51.4%;不完全应答组基线血清IgG水平显著高于缓解组(P＜0.05),肝组织病理学损伤更明显(P＜0.05)。结论部分DILI患者可能伴有自身免疫现象,或其发病机制即包括自身免疫反应。针对这部分患者,可以尝试免疫抑制剂治疗,但仍有部分患者对治疗不完全应答,还需要继续观察。

关键词: 药物性肝损伤, 自身免疫现象, 临床特征, 免疫抑制剂, 治疗

Abstract: Objective The purpose of this study was to summarize clinical feature of patients with drug-induced autoimmune-like hepatitis(DI-ALH). Method A retrospective analysis was conducted on clinical data of patients with drug-induced liver injury (DILI) in our hospital between January 2018 and January 2023, and all patients underwent liver biopsies. Immunosuppressant was given to those with autoimmune phenomenon. Result Of 312 patients with DILI, DI-ALH was found in 73 patients who presented as persistent liver injury after discontinuation of suspected medicine, elevated serum globulin level, and positive autoantibodies; percentage of herbal medicine-induced liver injury (HILI) in patients with DI-ALH was much higher than in patients with DILI(P＜0.05), serum cholinesterase level was much lower, while total serum bile acid (TBA), bilirubin, globumin and IgG levels were much higher than in patients with DILI (P＜0.05); liver histo-pathological injuries were more severe in patients with DI-ALH; of 70 patients with DI-ALH receiving immunosuppressant, disease remission (DR) rate was found as 48.6% and incomplete response (ICR) was 51.4% after three month treatment; baseline serum IgG levels in patients with ICR was much higher than in those with DR (P＜0.05), and liver injuries in ICR group were more severe (P＜0.05). Conclusion Autoimmune reaction might be involved in patients with DILI, especially in those who take herbal medicine, immunosuppressant might be tentatively given and the long-term efficacy still need observation.

Key words: Drug-induced autoimmune-like hepatitis, Clinical feature, Immunosuppressant, Therapy

马丹彤, 杨爽, 高丽丽, 高学松, 段雪飞. 伴有自身免疫现象的药物性肝损伤患者临床特征分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 390-393.

Ma Dantong, Yang Shuang, Gao Lili, et al. Clinical feature of patients with drug-induced autoimmune-like hepatitis: An analysis of 73 cases[J]. Journal of Practical Hepatology, 2025, 28(3): 390-393.

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伴有自身免疫现象的药物性肝损伤患者临床特征分析^*

Clinical feature of patients with drug-induced autoimmune-like hepatitis: An analysis of 73 cases

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