药物诱发自身免疫性肝炎、自身免疫性肝炎和药物性肝损伤患者临床特征分析*

doi:10.3969/j.issn.1672-5069.2026.04.017

摘要/Abstract

摘要： 目的探讨药物诱发自身免疫性肝炎(DILI-AIH)、自身免疫性肝炎(AIH)和药物性肝损伤(DILI)患者临床表现特征。方法 2023年6月～2025年6月我院诊治的DILI-AIH患者18例、AIH患者25例和 DILI患者32例,常规给予皮质激素和护肝治疗。均接受肝活检。结果 DILI-AIH组和AIH组女性占比和合并自身免疫性疾病发生率均显著高于DILI组(P<0.05);DILI组血清ALP和TBIL水平分别为242.1(164.5,333.2)U/L和86.3(45.7,140.2)μmol/L,均显著高于DILI-AIH组【分别为165.3(120.4,230.6)U/L和56.3(32.3,98.4)μmol/L,P<0.05】或AIH组【分别为130.3(105.4,193.4)U/L和48.2(25.2,80.4)μmol/L,P<0.05】,而血清IgG水平及ANA和SMA阳性率显著低于其他两组(P<0.05);DILI-AIH组和AIH组肝组织界面性肝炎和浆细胞浸润显著高于DILI组(P<0.05);DILI-AIH组和AIH组应用皮质激素占比显著高于DILI组(P<0.05),血清ALT恢复时间显著慢于DILI组(P<0.05),激素依赖和激素抵抗占比显著高于DILI组(P<0.05)。结论 DILI-AIH在临床表现、免疫学特征和组织病理学改变方面兼具DILI或AIH特征,其预后更接近AIH,提示其可能为药物触发的免疫介导性肝损伤。

关键词: 药物诱发自身免疫性肝炎, 药物性肝损伤, 自身免疫性肝炎, 临床特征

Abstract: Objective The aim of this study was to investigate clinical features of patients with drug-induced autoimmune hepatitis (DILI-AIH), autoimmune hepatitis (AIH) and drug-induced liver injury (DILI). Methods Clinical data from 18 patients with DILI-AIH, 25 patients with AIH and 32 patients with DILI were retrospectively collected between June 2023 and June 2025, and clinical materials, immunological manifestations, histopathological study and response to treatment were reviewed. Results Percentages of female and concomitant autoimmune diseases in patients with DILI-AIH and with AIH were much higher than in those with DILI(P<0.05);serum ALP total bilirubin levels in patients with DILI were 242.1(164.5,333.2)U/L and 86.3(45.7,140.2)μmol/L,both much higher than [165.3(120.4,230.6)U/L and 56.3(32.3,98.4)μmol/L,respectively, P<0.05] in those with DILI-AIH or [130.3(105.4,193.4)U/L and 48.2(25.2,80.4)μmol/L,respectively, P<0.05] in those AIH,while serum IgG level as well as serum ANA and SMA positive rates were much lower than in those with DILI-AIH or with AIH(P<0.05);incidences of liver tissue interface hepatitis and plasma cell infiltration in patients with DILI-AIH or with AIH were significantly higher than in those with DILI(P<0.05); all patients with DILI-AIH and with AHI received steroid therapy, but only a few with DILI did(P<0.05),and serum ALT level returning to normal took longer times than in those with DILI(P<0.05), with more steroid dependence or resistant to steroid in those DILI-AIH or with AIH (P<0.05). Conclusion DILI-AIH shares clinical, immunological, and histopathological features of both DILI and AIH, much similar to clinical manifestations and prognosis in patients with AIH. These findings suggest that DILI-AIH might represent an immune-mediated liver injury triggered by medicines. In individuals with a history of drug exposure accompanied with elevated serum IgG levels and positive autoantibodies, DILI-AIH should be considered. Early recognition and appropriate immunosuppressive therapy might improve long-term outcomes.

Key words: Drug-induced autoimmune hepatitis, Autoimmune hepatitis, Drug-induced liver injury, Clinical features

王坤, 王哲雅, 李俊娜. 药物诱发自身免疫性肝炎、自身免疫性肝炎和药物性肝损伤患者临床特征分析^*[J]. 实用肝脏病杂志, 2026, 29(4): 545-548.

Wang Kun, Wang Zeya, Li Junna, et al. Clinical features of patients with drug-induced autoimmune hepatitis, autoimmune hepatitis and drug-induced liver injury: A single center experience[J]. Journal of Practical Hepatology, 2026, 29(4): 545-548.

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药物诱发自身免疫性肝炎、自身免疫性肝炎和药物性肝损伤患者临床特征分析^*

Clinical features of patients with drug-induced autoimmune hepatitis, autoimmune hepatitis and drug-induced liver injury: A single center experience

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