Clinical Index Analysis Of The Similarities And Differences Of Drug-induced Liver Injury And Autoimmune Hepatitis

Drug-induced liver injury(Drug-induced liver injury, DILI) refers to the drugs or their metabolites in the process of Drug use cause of liver cell damage and liver toxicity of drugs and metabolites of allergic reaction caused by disease, may sometimes autoantibodies positive. The pathogenesis of DILI has not been fully elucidated, now consider mainly with drug metabolic abnormalities, immune injury, mitochondrial damage and genetic factors and so on. DILI is more acute drug-induced liver damage, there are a small number of patients may be because the varieties, dosage of drugs or specific reaction of the body to a drug may progress to liver failure and multiple complications, to life threatening. Foreign scholars divided AIH and DILI relations into three categories: immune- mediated DILI, drug mediated AIH and DILI with AIH, In which the immune-mediated DILI can appear serological and histological performance of AIH, the disease alleviate after relevant treatment discontinuation, but it is not a real AIH, still belongs to the category of DILI. Autoimmune hepatitis(AIH) was mediated by abnormal immune reaction of persistent chronic inflammation of the liver parenchyma lesions, with liver function injury, with its own antibody positive serum, and high gamma globulin hematic disease and on the immune inhibitor response characteristics. Pathological features is Interface inflammation, collect abbacy lymphocyte/plasma cell infiltrates, and liver cells arranged in a rosette samples, become a histologic criteria for diagnosis of AIH. Positive serum autoantibodies can appear in drug-induced liver injury and autoimmune hepatitis, before our regular clinical thinking is against liver damage first ruled out in patients with viral hepatitis, alcoholic liver injury, genetic metabolic diseases, such as detect antibody positive in their own right, can consider to the diagnosis of AIH, its own antibody positive detection is important in the diagnosis of AIH, But it is lack of specificity of AIH diagnosis. Drug-induced liver injury and autoimmune hepatitis patients are lack of specificity in clinical manifestation and laboratory examination, and both have certain correlation, it is difficult for clinical differential diagnosis. But the principle of treatment and prognosis are different, so how to give to begin with the correct differential diagnosis and proper treatment are clinicians need to attach importance to the problem.Object: To explore clinical index analysis of the similarities and differences of drug-induced liver injury and autoimmune hepatitis, including the general clinical data, biochemistry, immunology, pathology characteristics, etc.Materials: Using retrospective analysis method, the choice in January 2009-August 2015 in the first hospital of jilin university Gan Dan Yi medical diagnosis of 163 cases of hospitalized patients with DILI, 59 cases of men, 104 cases of women, with an average age of 46 ± 16 years old; 60 cases of hospitalized patients with AIH, 2 cases of men, 58 cases of women, with an average age of 58±11 years old. DILI clinical diagnosis based on detailed medical history, laboratory examination, liver biopsy, eliminate Non-drug liver damage, etc. The clinical diagnosis of AIH is according to rule out medication history, its own antibody positive, liver biopsy, AIH simplified diagnosis points system, etc. Collected the clinical data of initial diagnosis, record the age, sex, clinical symptoms, liver function, blood coagulation function, autoantibodies and liver biopsy pathology, etc.Methods: Liver function and blood coagulation routine, ANA series take on an empty stomach blood is equal to the hospital early the next morning, the American BECKMAN company SYNCHRON LX20 automatic biochemical analysis system and auxiliary reagent for testing. By indirect immunofluorescence method to test Anti nuclear antibody, Anti smooth muscle antibody, Anti-mitochondria antibody and Anti liver-kidney microsomal antibody etc. Liver histologic examination under the ultrasonic position- ning, percutaneous liver biopsy to get pathological tissue, biopsy specimens by regular fixed, dyeing processing, such as reading by two senior pathologist.Results:(1) The general clinical data: The patients of DILI group and AIH group were seen more women, DILI group morbidity peak ages 21 to 60, AIH group morbidity peak age 40 and older patients, two groups there were significant differences in age distribution.(2) Clinical manifestations: DILI group and AIH group major clinical manifestations were weakness, abdominal distension, urine color deepened, fever, skin itch and so on, there was no statistically significant difference.(3) Blood biochemical data: DILI and AIH groups of PTA, ALP, GGT index results are similar, there was no statistically significant difference, But ALT, AST, ALB,CHE, TBil, DBil levels of DILI group were higher than in AIH group, P values < 0.05, the difference was statistically significant.(4) Immunology data: Patients of AIH group with ANA series of 1:100, 1:1000, 1:32 00 were more than DILI group, P values <0.05, the difference is statistically significant, but 1:320 P values >0.05, there was no statistically significant difference; AIH autoantibody positive rate higher than that of DILI group, P values <0.05, the difference was statistically significant; Ig G, Ig M and Ig A patients of AIH group were higher than that of DILI group, P values <0.05, the difference was statistically significant. Identification of DILI and AIH Ig G, IGM and Ig A best threshold value is 15.250, 1.345, 2.8150, respectively, the corresponding sensitivity was 91.7%, 63.3% and 83.3%, respectively, specific degree is 85.9%, 84.8%, 87.0%,respectively.(5) Pathology data: Infiltrating lymphocytes/plasma cells、liver cell rosette sample structure in pathology of AIH patients is more than DILI group, P values <0.05, But the interface inflammation are common between the two, P values >0.05, no statistical difference.(6) Diagnostic score: The median of the simplified AIH scoring in AIH group is 7 points, higher than in DILI group 3 points, P values <0.05, the difference was statistically significant.(7) Prognosis: The prognosis of patients with DILI group and AIH groups exist significant differences, P values <0.01, DILI group prognosis is better.Conclusion:(1) Patients with antinuclear antibody positive, DILI group in middle and low drop degree is given priority to, by AIH group in middle and high drop degree is given priority to, when Ig G, IGM and Ig A values more than 15.250, 1.345, 2.8150, respectively, the diagnosis is more inclined to AIH, the Ig G for high sensitivity and specificity of AIH diagnosis is very high,more value to the diagnosis of AIH, immune globulin detection rate, autoimmune liver disease Ig G antibody positive rate and the simplified AIH scoring can well distinguish them.(2) Infiltrating lymphocytes/plasma cells, liver cell rosette sample structure are more specificity for AIH, liver biopsy is of great significance to identify their diagnostic.