自身免疫性肝炎和药物性肝损伤患者临床病理特征分析*

doi:10.3969/j.issn.1672-5069.2023.02.017

摘要/Abstract

摘要： 目的探讨自身免疫性肝炎(AIH)与药物性肝损伤(DILI)患者临床和肝组织病理学损伤的差异,为临床鉴别和诊治提供帮助。方法 2018年1月～2022年3月我院收治的AIH患者62例和DILI患者104例,均接受肝活检,采用Ishak评分系统评价肝组织炎症和纤维化程度。结果 AIH组女性占比为75.8%,显著高于DILI组的53.8%,差异具有统计学意义(P<0.05), AIH组血清谷草转氨酶和免疫球蛋白G(IgG)分别为134(58,312)U/L和17.4(12.8,20.4)mg/dL,显著高于DILI组【分别为57(32,135)U/L和13.6(10.9,15.7)mg/dL,P<0.05】,而血清白蛋白水平为37.0(32.4,40.6)g/L,显著低于DILI组【(42.2(36.8,44.3)g/L,P<0.05】;AIH组肝组织表现为界面性肝炎、浆细胞浸润、玫瑰花结形成和淋巴细胞穿入发生率分别为91.9%、71.0%、62.9%和51.6%,均显著高于DILI组(分别为16.3%、29.8%、21.1%和17.3%,P<0.05);AIH组肝纤维化评分为0分、1分、2分、3分、4分、5分和6分发生率分别为6.4%、6.4%、9.7%、50.0%、14.5%、8.1%和4.8%,而DILI组则分别为25.0%、35.6%、29.8%、7.7%、1.9%、0.0%和0.0%,差异具有统计学意义(P<0.05),提示AIH组肝纤维化显著重于DILI组。结论 AIH与DILI患者在血生化、血清免疫球蛋白和肝组织病理学表现上存在较大的差异,因为AIH以女性多见,肝组织界面性和肝纤维化程度更为突出,可以帮助临床医生鉴别。

关键词: 自身免疫性肝炎, 药物性肝损伤, 免疫球蛋白, 界面性肝炎, 肝纤维化

Abstract: Objective The aim of this study was to compare the clinicopathological features between patients with autoimmune hepatitis (AIH) and drug-induced liver injury (DILI). Methods 62 patients with AIH and 104 patients with DILI were encountered in our hospital between January 2018 and March 2022, and all underwent liver biopsies. The hepatic inflammation and fibrosis was evaluated by Ishak scores. Results The percentage of female cases in patients with AIH was 75.8%, much higher than 53.8% in patients with DILI (P<0.05); serum AST and immunoglobulin G levels in patients with AIH were 134(58, 312)U/L and 17.4(12.8, 20.4)mg/dL, significantly higher than [57(32, 135)U/L and 13.6(10.9, 15.7)mg/dL, respectively, P<0.05], while serum albumin level was 37.0(32.4, 40.6)g/L, significantly lower than [(42.2(36.8, 44.3)g/L, P<0.05] in patients with DILI; the incidence of interfacial hepatitis, plasma cell infiltration, rosette formation and lymphocyte infiltration in patients with AIH were 91.9%, 71.0%, 62.9% and 51.6%, all significantly higher than 16.3%, 29.8%, 21.1% and 17.3%, respectively, in patients with DILI (P<0.05); the incidences of fibrosis score 0, 1, 2, 3, 4, 5 and 6 in patients with AIH were 6.4%, 6.4%, 9.7%, 50.0%, 14.5%, 8.1% and 4.8%, significantly different compared to 25.0%, 35.6%, 29.8%, 7.7%, 1.9%, 0.0% and 0.0% in patients with DILI (P<0.05), suggesting more severe fibrosis in patients with AIH. Conclusion There are differences as respect to blood biochemistry, plasma immunoglobulin, and liver histopathology between patients with AIH and DILI, and among them, the liver tissue changes in patients with AIH is characterized by interfacial hepatitis, portal inflammation and liver fibrosis, which might help differentiate them.

Key words: Autoimmune hepatitis, Drug-induced liver injury, Immunoglobulin, Interfacial hepatitis, Liver fibrosis

王焱, 周静, 韩军. 自身免疫性肝炎和药物性肝损伤患者临床病理特征分析^*[J]. 实用肝脏病杂志, 2023, 26(2): 218-221.

Wang Yan, Zhou Jing, Han Jun. Clinicopathological features of patients with autoimmune hepatitis and drug-induced liver injury[J]. Journal of Practical Hepatology, 2023, 26(2): 218-221.

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自身免疫性肝炎和药物性肝损伤患者临床病理特征分析^*

Clinicopathological features of patients with autoimmune hepatitis and drug-induced liver injury

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