伴自身免疫现象的药物性肝损伤的临床和病理特点
|
摘要
目的:分析伴自身免疫现象的药物性肝损伤(DILI)的临床和病理特点。方法:2013年8月~2017年1月在我院住院治疗的DILI患者93例,按照自身抗体检查和肝穿检查结果分为观察组(伴自身免疫现象)55例,和对照组(不伴自身免疫现象)38例。观察其症状体征、实验室指标、病理检查及治疗效果。结果:观察组患者血清门冬氨酸氨基转移酶、总蛋白及免疫球蛋白G[320.5(36.5,1172.3)U/L、68.5±8.0g/L、15.3±5.1g/L]均显著高于对照组[142.6(25.7,2438.8)U/L、64.7±7.8g/L、12.3±4.4g/L](均P<0.05),2组患者病理特征比较,无显著性差异(P>0.05);随访6个月,观察组中急性转为慢性患者7例(17.9%),对照组2例(8.3%);5例(9.1%)确诊为药物诱发的自身免疫性肝炎。结论:单纯DILI与伴有自身免疫性现象DILI相比,病理损伤特征与临床症状相似,但随着病情发展伴有自身免疫性现象DILI有慢性化趋势,部分患者可发展为诱发的自身免疫性肝炎,因此临床上需监测伴自身免疫现象的DILI病情变化并适时修正诊断。
Objective:To analyze the clinical and pathological characteristics of drug-induced liver injury(DILI)accompanied by autoimmune phenomena.Methods:An analysis was performed in the clinical data of 93 patients with DILI who were admitted to Beijing Youan Hospital from Aug 2011 to Jan 2013.The participants were divided into DILI accompanied by autoimmune phenomena group(investigation group,55 cases)and the control group(38 cases)according to the results of autoantibodies and liver biopsy test.The parameters,histopathological changes and curative effects were analyzed.Results:The levels of serum aspartate aminotransferase,total protein and immunoglobulin G of the patients in the investigation group [320.5(36.5,1172.3)U/L,68.5±8.0 g/L,15.3±5.1]were higher than those of the control group [142.6(25.7,2438.8)U/L,64.7±7.8 g/L,12.3±4.4](P<0.05).There was no significant difference between the two groups in the pathological characteristics between the two groups(P>0.05).After 6 months follow-up,7 cases(17.9%)of acute patients turned chronic in the investigation group,and 2 cases(8.3%)occurred in the control group.But there were no significant difference between the two groups.Five patients were diagnosed as drug-induced autoimmune hepatitis.Conclusion:The clinical symptoms and pathological features are similar in DILI.But there is a chronic tendency of DILI companied by autoimmune phenomenon and they may turn into the autoimmune hepatitis.Attentions should be paid to these patients and timely correction of the diagnosis is needed.
Objective:To analyze the clinical and pathological characteristics of drug-induced liver injury(DILI)accompanied by autoimmune phenomena.Methods:An analysis was performed in the clinical data of 93 patients with DILI who were admitted to Beijing Youan Hospital from Aug 2011 to Jan 2013.The participants were divided into DILI accompanied by autoimmune phenomena group(investigation group,55 cases)and the control group(38 cases)according to the results of autoantibodies and liver biopsy test.The parameters,histopathological changes and curative effects were analyzed.Results:The levels of serum aspartate aminotransferase,total protein and immunoglobulin G of the patients in the investigation group [320.5(36.5,1172.3)U/L,68.5±8.0 g/L,15.3±5.1]were higher than those of the control group [142.6(25.7,2438.8)U/L,64.7±7.8 g/L,12.3±4.4](P<0.05).There was no significant difference between the two groups in the pathological characteristics between the two groups(P>0.05).After 6 months follow-up,7 cases(17.9%)of acute patients turned chronic in the investigation group,and 2 cases(8.3%)occurred in the control group.But there were no significant difference between the two groups.Five patients were diagnosed as drug-induced autoimmune hepatitis.Conclusion:The clinical symptoms and pathological features are similar in DILI.But there is a chronic tendency of DILI companied by autoimmune phenomenon and they may turn into the autoimmune hepatitis.Attentions should be paid to these patients and timely correction of the diagnosis is needed.
引文
[1] European Association for the Study of the Liver.EASL Clinical Practice Guidelines:Autoim mune hepatitis[J].J Hepatol,2015,63(4):971-1004.
[2]中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].中华肝脏病杂志,2015,23(11):810-820.
[3] Danan G,Beniehou C.Causality assessment of adverse reactions to Drugs-A novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries[J].J Clin Epidemiol,1993,46:1323-1330.
[4] Castiella A,Zapata E,Lucena MI,et al.Drug-induced autoimmune liver disease:A diagnostic dilemma of an increasingly reported disease[J].World Journal of Hepatology,2014,6(4):160.
[5] Weiler-Normann C,Schramm C.Drug induced liver injury and its relationship to autoimmune hepatitis[J].J Hepatol,2011,55:747-749.
[6] Alvarez F,Berg PA,Bianchi FB,et al.International autoimmune hepatitis group report:review of criteria for diagnosis of autoimmune hepatitis[J].J Hepatol,1999,31(5):929-938.
[7] Chalasani NP,Hayashi PH,Bonkovsky HL,et al.ACG clinical guideline:the diagnosis and management of idiosyncratic drug-induced liver injury[J].Am J Gastroenterol,2014,109(7):950-966.
[8]陈杰,梁珊,范作鹏,等.慢性药物性胆汁淤积性肝病34例临床特点分析[J].疑难病杂志,2017,16(4):400-402,406.
[9]刘晖,孔贺利,张世杰,等.自身抗体阳性的药物性肝损伤患者的临床病理特征[J].中国医药导报,2016,13(36):63-66,封4.
[10]周晓丽,梁庆升,孙颖,等.自身免疫样药物性肝损伤研究进展[J].肝脏,2017,22(5):460-463.
[11] Bjornsson E,Talwalkar J,Treeprasertsuk S,et al.Drug-induced autoimmune hepatitis:clinical characteristics and prognosis[J].Hepatology,2010,51(6):2040-2048.
[12] Stine JG,Chalasani N.Chronic liver injury induced by drugs:a systematic review[J].Liver International,2015,35(11):2343-2353.
[13]黄春洋,刘燕敏,黄云丽,等.药物性肝损伤患者伴自身免疫现象的临床特点分析[J].临床肝胆病杂志,2015,31(8):1303-1306.
[14]张韫,赵宗江,李忻,等.黄连素对2型糖尿病大鼠脂肪肝的治疗作用及机制研究[J].中日友好医院学报,2018,32(1):23-27.
[2]中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].中华肝脏病杂志,2015,23(11):810-820.
[3] Danan G,Beniehou C.Causality assessment of adverse reactions to Drugs-A novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries[J].J Clin Epidemiol,1993,46:1323-1330.
[4] Castiella A,Zapata E,Lucena MI,et al.Drug-induced autoimmune liver disease:A diagnostic dilemma of an increasingly reported disease[J].World Journal of Hepatology,2014,6(4):160.
[5] Weiler-Normann C,Schramm C.Drug induced liver injury and its relationship to autoimmune hepatitis[J].J Hepatol,2011,55:747-749.
[6] Alvarez F,Berg PA,Bianchi FB,et al.International autoimmune hepatitis group report:review of criteria for diagnosis of autoimmune hepatitis[J].J Hepatol,1999,31(5):929-938.
[7] Chalasani NP,Hayashi PH,Bonkovsky HL,et al.ACG clinical guideline:the diagnosis and management of idiosyncratic drug-induced liver injury[J].Am J Gastroenterol,2014,109(7):950-966.
[8]陈杰,梁珊,范作鹏,等.慢性药物性胆汁淤积性肝病34例临床特点分析[J].疑难病杂志,2017,16(4):400-402,406.
[9]刘晖,孔贺利,张世杰,等.自身抗体阳性的药物性肝损伤患者的临床病理特征[J].中国医药导报,2016,13(36):63-66,封4.
[10]周晓丽,梁庆升,孙颖,等.自身免疫样药物性肝损伤研究进展[J].肝脏,2017,22(5):460-463.
[11] Bjornsson E,Talwalkar J,Treeprasertsuk S,et al.Drug-induced autoimmune hepatitis:clinical characteristics and prognosis[J].Hepatology,2010,51(6):2040-2048.
[12] Stine JG,Chalasani N.Chronic liver injury induced by drugs:a systematic review[J].Liver International,2015,35(11):2343-2353.
[13]黄春洋,刘燕敏,黄云丽,等.药物性肝损伤患者伴自身免疫现象的临床特点分析[J].临床肝胆病杂志,2015,31(8):1303-1306.
[14]张韫,赵宗江,李忻,等.黄连素对2型糖尿病大鼠脂肪肝的治疗作用及机制研究[J].中日友好医院学报,2018,32(1):23-27.