药物诱导性自身免疫性肝炎临床特征分析

Analysis of the clinical characteristics of drug-induced autoimmune hepatitis

目的分析药物诱导性自身免疫性肝炎(DIAIH)与药物性肝损伤(DILI)和自身免疫性肝炎(AIH)的临床特征差异。方法将患者分为3组:DIAIH组、DILI组与AIH组。回顾性分析和比较3组患者的年龄、性别、用药史、主要临床症状、生化指标、白细胞计数及分类、并发肝外自身免疫性疾病。结果发病年龄:DIAIH组较DILI组更大(P<0.05)。诱发DIAIH的药物:中草药占构成比最大(42.8%)。DIAIH组、DILI组的谷氨酰转肽酶(GGT)水平分别为199.00(117.25,384.25)和105.00(48.00,228.00)U·L^(-1);球蛋白(G)水平分别为31.00(25.65,39.25)和27.50(23.80,31.20)g·L^(-1);总胆汁酸(TBA)水平分别为21.50(11.00,82.50)和6.00(3.00,27.00)μmol·L^(-1),组间比较差异均有统计学意义(均P<0.05)。DIAIH组、AIH组的谷丙转氨酶(GPT)水平分别为326.65(128.78,503.00)和89.50(35.75,174.50);谷草转氨酶(GOT)水平分别为254.90(82.25,327.00)和61.50(43.00,152.08);碱性磷酸酶(ALP)水平分别为127.00(93.50,150.50)和179.50(99.00,321.75)U·L^(-1),组间比较差异均有统计学意义(均P<0.05)。结论DIAIH组最常见的诱发药物是中草药,血清GGT、G、TBA升高较DILI组更显著,GPT、GOT升高较AIH组更明显;但ALP较低。

ObjectiveTo analyze of drug-induced autoimmune hepatitis(DIAIH)with drug-induced liver injury(DILI)and autoimmune hepatitis(AIH)have differences in clinical characteristics.Methods The patients were divided into three groups:DIAIH group,DILI group,AIH group.Retrospective analysis and comparison of three groups of patients on the age,gender,medication history,main clinical symptoms,biochemical indexes,leukocyte count and classification,extrahepatic autoimmune diseases.Results The onset age of DIAIH group was older than DILI group(P<0.05).Among the drugs inducing DIAIH,accounted for the largest proportion of Chinese herbal medicine(42.8%).The levels of glutamyl transpeptidase(GGT)in serum of DIAIH group and DILI group were 199.00(117.25,384.25)and 105.00(48.00,228.00)U·L^(-1);globulin(G)were 31.00(25.65,39.25)and27.50(23.80,31.20)g·L^(-1);total bile acid(TBA)were 21.50(11.00,82.50)and 6.00(3.00,27.00)μmol·L^(-1),the difference of above factors were significant(all P<0.05).The levels of glutamic-pyruvic transaminase(GPT)in serum of DIAIH group and DILI group were 326.65(128.78,503.00)and 89.50(35.75,174.50);glutamic-oxaloacetic transaminase(GOT)were 254.90(82.25,327.00)and 61.50(43.00,152.08);alkaline phosphatase(ALP)were 127.00(93.50,150.50)and 179.50(99.00,321.75)U·L^(-1),the difference of above factors were significant(all P<0.05).Conclusion The most common inducing drug of DIAIH is Chinese herbal medicine.The increase of serum GGT,G and TBA is more significant than that of the DILI group,the increase of GPT and GOT is more significant than that of the AIH group,but the ALP was lower.