药物诱导性自身免疫性肝炎与药物性肝损伤和自身免疫性肝炎患者临床特征比较研究*

doi:10.3969/j.issn.1672-5069.2023.04.015

Abstract

Abstract: Objective The aim of this study was conducted to compare the clinical features of patients with drug-induced autoimmune hepatitis (DI-AIH), autoimmune hepatitis (AIH) and drug-induced liver injury (DILI). Methods 22 patients with DI-AIH, 23 patients with DILI and 23 patients with AIH were encountered in our hospital between January 2017 and December 2021, the patients with AIH and DI-AIH were treated with prednisone and/or azathioprine combination therapy, and those with DILI were dealt with liver-protecting medicines. All patients were followed-up for two years. Results The percentages of definite medicine administered before diagnosis of patients with DILI and DI-AIH were 82.6% and 100.0%, with the alleged Chinese herbal medicine mainly, both significantly higher than 17.4%(P<0.05) in patients with AIH; the incidence of common symptoms, such as anorexia, jaundice and diarrhea in patients with DI-AIH was 81.8%, much higher than 52.2% and 47.8% (P<0.05) in those with AIH or with DILI; serum alanine aminotransaminase, alkaline phosphatase, glutamine transpeptidase and total bile acid levels in patients with DI-AIH were 331.2(116.4, 512.5) U/L, 125.4(91.6, 164.8) U/L, 202.4(98.8, 394.1) U/L and 23.7(13.1, 69.7)μmol/L, all significantly higher than [198.6(94.3, 497.6)U/L, 98.9(67.7, 168.9)U/L, 101.2(49.6, 231.4)U/L and 7.1(2.7, 29.2)μmol/L, respectively, P<0.05] in patients with DILI or [86.7(32.4, 186.3)U/L, 65.8(54.7, 109.8)U/L, 71.6(61.4, 142.5)U/L and 11.5(4.1, 35.6)μmol/L, respectively, P<0.05] in patients with AIH, while serum globulin level in patients with AIH was 35.6(28.7, 41.4) g/L, significantly higher than 28.8(21.2, 34.5) g/L in patients with DILI (P<0.05) or 30.5(24.6, 42.1)g/L in patients with DI-AIH (P<0.05); there were no significant differences as respect to peripheral white blood cell counts among the three groups (P＞0.05). Conclusion The main pathogenic medicines in patients with DILI and DI-AIH are Chinese herbal medicine, and the clinical features of patients with DI-AIH are unique, presenting with highly increased serum biochemical parameters and good prognosis, showing response to immunosuppression and liver-protecting therapy.

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

Fu Xinyin, Lin Xiaoru, Zheng Xiufen, et al. Comparison of clinical features of patients with drug-induced autoimmune hepatitis, autoimmune hepatitis and drug-induced liver injury[J]. Journal of Practical Hepatology, 2023, 26(4): 512-515.

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Comparison of clinical features of patients with drug-induced autoimmune hepatitis, autoimmune hepatitis and drug-induced liver injury

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