The Determination And Clinical Significance Of Autoantibody Series In Patients With Drug-induced Liver Injury

Research purpose: The determination of autoantibodies in patients with druginduced liver injury is to explore the related factors influencing the expression of autoantibodies in drug-induced hepatitis and the clinical significance of the inmune mechanism of drug-induced liver injury.Methods: From January 2014 to January 2018,we retrospectively reviewed the clinical diagnosis of drug-induced hepatitis in our hospital.All patients underwent autoimmune liver disease antibody series and ANA antibody series examination.We record the sex and age of patients,drug history,liver function change and prognosis of clinical treatment etc.,and calculate the detection rate of positive autoantibodies.Results:1.6 kinds of autoantibodies are detected in DILI patients,including ANA,AMA,PML,Ro52,gp210 and Sp100.Among them,the proportion of ANA is the highest,70.8%.The ANA titer is mainly low titer(72%).The fluorescence models detected include nuclear granule type,cytoplasmic granule type,nuclear homogeneous type,nuclear membrane type,nucleolar type and centromere type,and the proportion of nuclear granular type is the largest(69.33%).2.The ratio of male and female in DILI patients is 2:1.The positive rate of autoantibody is 81.43% in female patients and 70.59% in male patients.The results are not statistically significant(P>0.05).The minimum age of the patients is 21;The maximum age is 82 years old and the average age is 49.63 + 13.44 years old.The positive rate of autoantibodies of less than 40 years old age group is 78.57%;the positive rate of 41-60 years old group is 83.36% and the positive rate of more than 61 years old group is 70%.But there is no significant difference in Statistics(P>0.05).3.The main drugs leading to DILI include traditional herbal medicine,cardiovascular drugs,antipyretics,antibiotics,antithyroid drugs,digestive system drugs,antituberculous drugs and other rare drugs.Chinese herbal medicine accounts for the largest proportion,57.7%.The antibody positive rate of herbal medicine group is 80% and 75% in the western medicine group.However,there is no statistical significance(P>0.05).4.DILI patients are divided into 2 groups according to the time of medication:?1 month and >1 month.The detection rate of autoantibodies of patients using drugs within 1 month is 88.7% while the other group is 61.9%,and the difference is statistically significant(P<0.05).5.Among the 104 DILI patients,there are 59 hepatocyte injury type,25 cholestasis type,and 20 mixed type.The positive rates of their autoantibodies are 79.70%,84% and 65% respectively.There is no statistically significant difference in the 3 groups(P>0.05).The autoantibody detection rate in patients with different grade severity differs:the first grade 79.5%,the second grade 66.7%,the third grade 94.7%,the forth grade 76.5%.But there is no statistical significance among the groups(P>0.05).6.In 23 cases of DILI patients with negative autoantibody,15(65.22%)cases of liver function return to normal after 2 weeks of treatment,and only 24(29.63%)cases of liver function return to normal after 2 weeks of treatment with positive autoantibody.The difference is statistically significant(P< 0.05).At 4 weeks,the autoantibody negative group has 18 cases(78.26%)whose liver function recover to normal,and 41(50.62%)patients in the autoantibody positive group recover to normal.The difference is statistically significant(P<0.05);At 12 weeks,the autoantibody negative groups all return to normal,while 28 cases of autoantibody positive group still have abnormal liver function,and the difference is statistically significant(P<0.05).Conclusion: The detection rate of autoantibodies in DILI patients is 77.88%.ANA is the most common in all kinds of autoantibodies,accounting for 70.8%,and most of the fluorescence models is nuclear granule type with low titer.The drugs that cause DILI are mainly traditional herbal medicine.There is no significant difference in the detection rate of autoantibodies between herbal medicine group and Western medicine group.The positive rate of autoantibodies in DILI patients is not related to sex,age,clinical classification and severity.It is related to the time of medication.The longer the medication time,the greater the positive rate of autoantibodies.The time needed for liver injury repair in patients with autoantibody positive DILI is longer than those without autoantibodies in DILI patients after clinical routine treatment.