Comparison Of The Clinical Features Between Primary Biliary Cirrhosis And Drug-induced Liver Injury

Objective: Primary Biliary Cirrhosis(PBC) is a chronic autoimmune liver disease,which the microscopic performance is the interlobular bile duct was destroyed,gradually progress to the bile duct obstruc-tion and cholestasis,causes liver fibrosis,liver cirrhosis,finally lead to liver failure.The causes of PBC are unknown,Studies have shown that genetic factors and environmental factors are closely tied up with the progress of PBC.Early years some epidemiological studies have reported the annual incidence is about 2.27-32/million people,middle aged women see more,female:male=9:1,According to the number of PBC cases reported in recent years in the world scope,we can find its incidence increased year by year,the occurrence of race and nation is not subject to regional restrictions,the highest incidence of countries for North America and Northern Europe.It’s insidious onset slowly,the number of the asymptomatic patients accounts for 20%-60% of the first diagnosed patients,As the disease progressing,the related symptoms will eventually appear,mostly in 2-4 years.Therefore,as a result earlier diagnosis and treatment is essential to the development and prognosis of the disease.The prognosis of PBC is very different,after several years the quality of life of patients can not be affected by the disease,the lesions progress is slow,the patient can survive long.After active treatment of Internal Medicine,the patient’s symptom of skin itching disappeared、xanthelasma atrophy 、 serum cholesterol decreased,all of these tips to good prognosis.Persistently elevated serum bilirubin 、 accompanied by autoimmune disorders、histological changes in progress,all of these tips to bad prognosis.Its final performance and common cause of death as similar as other types of liver cirrhosis:Esophageal varices and portal hypertension 、 infected 、 liver or kidney function failure,and so on.Drug-induced liver injury also called drug hepatitis, its meaning is when doctors use drugs to treat certain diseases in clinic, the medicine take by oraly or vein can lead to liver damage. Its clinical features and pathology are lack of specificity. DILI caused by many types of drugs. In traditional Chinese medicine, antineopastic agents, anti-thyroid drugs, antibiotics, anti-TB drugs based. Its incidence is increasing year by year. Statistical reports DILI common cause of death in the world arranged in fifth. After antive and effective treatment, most of prognosis is good performance, except in patients with liver diease who long-term use of antineoplaseic drugs, traditional Chinese medicine or anti-tuberculosis drugs. Maybe associated with underlying disease affecting its liver tolerance, The purpose is to discuss the similarities and differences between primary biliary cirrhosis and Drug-induced liver injury in the average age,sex,clinical manifestations,laboratory tests,complications and other aspects, including through drug-induced antoimmune liver disease or druginduced liver damage on the basis of PBC. Comparing the difference, to guide clinical diagnosis and treatment.Data and Methods:Admission data of patients with primary biliary cirrhosis(PBC) who came to the First Affiliated Hospital of Dalian Medical University,from January 2005 to January 2015 were retrospectively analyzed and collected.Studied the annual incidence rate,and randomly selected 30 cases for the study(5 males and 25 females,43-85 years old,the average age is 66±10),to observe the aspects on sex,the age of onset,medication history,clinical manifestation,imaging examination,laboratory examination,complication, And to compare with 30 patients with drug induced liver injury at the same period(12 males and 18 females,18-83 years old,the average age is 48±14).Results:1.Statistics about the patients with primary biliary cirrhosis and drug induced liver injury who came to the Firlt Affiliated Hospital of Dalian Medical University from 2005 to 2015,its incidence is increasing year by year,it reminds us that the patients with PBC and DILI diagnosed by laboratory examination or liver biopsy is increasing year by year.2.There were 60 patients altogether,25 women in the group PBC,accounting for 83% of this group,18 women in the group DILI,accounting for 60% of this group,so the prevalence of female in group PBC was significantly higher than that in the group DILI.The difference was significant(P<0.05).The average age of onset in group PBC was significantly higher than that in the group DILI.The difference was significant(P<0.01).y3.Studies have shown that for some individuals who have genetic and immunological idiosyncrasy,can cause PBC induced by drugs.In the medicine which can induce to the liver damage,the most common type is the Chinese herbal medicine,western medicine mainly includes antineoplastic agents,anti thyroid drugs, antibiotics,anti tuberculosis drugs.(Arranged in the order from high to low).4.In these 60 patients,the main clinical features of the patients with PBC were jaundice,weak,abdominal distention,loss of appetite,itchy skin.But the main clinical features of the patients with DILI were jaundice,weak,loss of appetite.5.We can see the morphological changes of the liver from CT examination(rugged,uneven density) in both two groups,some patients with PBC showed hepatomegaly,splenomegaly,ascites and esophageal varices and so on.6.The biochemical parameters were abnormal in varying degrees of all these patients:ALT、ALB、ALP increased more significantly in the group PBC compared with the group DILI.And the difference was significant(P <0.05).The erythrocyte sedimentation rate increased more significantly in the group PBC,compared with the group DILI.And the difference was significant(P<0.05).7.Patients in the group PBC can have different degrees of concurrent disease.For example:hemorrhage of upper digestive tract,infected,hepatic encephalopathy,primary carcinoma of the liver, and so on.The incidence of drug-induced liver injury patients complicated with disease is very small.The incidence of complications of two kinds of liver diseases has no statistical difference(P>0.05).Conclusion:The annual incidence of PBC is in a increasing trend which suggested a growing number of patients with PBC were detected.Cmpared with drug-induced liver injury,PBC occurs in middle-aged female patients,the occurrence of partial disease in connection with chronic drug hepatitis,the main clinical manifestations of the patients with PBC are itchy skin,jaundice.ALP、GGT and bilirubin increased significantly,and the erythrocyte sedimentation rate is elevated,it can be complicated by a variety of clinical symptoms,like upper gastrointestinal bleeding,infection,hepatic encephalopathy,and so on.So it has its own significant clinical characteristics.The patients with DILI are lack of specificity in terms of age,the most common drug which can induce to liver damage is the Chinese herbal medicine,the main clinical manifestations of the patients with DILI are fatigue,fever,nausea and vomiting,skin itching,and so on.ALT、AST 、GGT increased significantly.The prognosis is good after stopping medicine or liver protection therapy.