自身免疫性样表现的药物性肝损伤患者的血清学及组织学特征

The serological and histological characteristics of drug-induced liver injury patients with autoimmune-like manifestations

目的探讨自身免疫性样表现的药物性肝损伤(AL-DILI)患者的血清学及组织学特征。方法选取2016年7月至2021年8月入院诊治DILI患者75例,根据是否存在自身免疫样表现将患者分为观察组(n=42)和对照组(n=33),比较2组患者基本情况、血清学特征以及组织学特征。结果观察组女性患者29例(87.9%),高于对照组26例(61.9%)(P<0.05)。观察组AST、GGT、球蛋白、IgG以及IgA水平分别为220.0(79.9,398.9)U/L、187.5(105.8,299.5)U/L、30.6(27.9,34.1)g/L、14.9(12.8,18.2)g/L和2.9(2.3,3.4)g/L,高于对照组的95.1(60.3,276.5)U/L、104.5(51.5,205.5)U/L、26.3(24.4,28.0)g/L、10.1(8.7,12.6)g/L和2.0(1.5,2.8)g/L,差异有统计学意义(P<0.05),而ChE水平为5626(4812,7356)U/L,低于对照组的6981(5328,8096)U/L,差异有统计学意义(P<0.05)。观察组嗜酸性粒细胞和(或)中性粒细胞浸润的比例为54.8%(23/42),高于对照组的15.2%(5/33),差异有统计学意义(P<0.05)。结论血清学及组织学特征的不同有助于区分AL-DILI和单纯DILI。

Objective To investigate the serological and histological characteristics of drug-induced liver injury(AL-DILI)patients with autoimmune-like manifestations.Methods Seventy-five DILI patients admitted to hospital between July 2016 and August 2021 were divided into two groups according to whether they had autoimmune manifestations.The basic conditions,serological and histological characteristics of the patients were compared.Results 87.9%of the patients in the observation group were female,which were significantly higher than that of 61.9%in the control group(P<0.05).Comparing the serological characteristics of the observation group and the control group,The levels of AST,GGT,globulin,IgG and IgA in the observation group were 220.0(79.9,398.9)U/L,187.5(105.8,299.5)U/L,30.6(27.9,34.1)g/L,14.9(12.8,18.2)g/L and 2.9(2.3,3.4)g/L,respectively,which were significantly higher than those of[95.1(60.3,276.5)U/L,104.5(51.5,205.5)U/L,26.3(24.4,28.0)g/L,10.1(8.7,12.6)g/L and 2.0(1.5,2.8)g/L]in the control group(P<0.05).The level of ChE was 5626(4812,7356)U/L in the observation group,which was significantly lower than that of[6981(5328,8096)U/L]in the control group(P<0.05).Comparing the histological characteristics of the observation group and the control group,the proportion of eosinophil and/or neutrophil infiltration in the observation group was 54.8%,which was significantly higher than that of 15.2%in the control group(P<0.05).Conclusion The difference of serological and histological characteristics is helpful to distinguish AL-DILI from simple DILI,which provides a theoretical basis for their differential diagnosis.