Clinical Characteristics And Differentiation Of Drug-induced Liver Injury And Autoimmune Hepatitis

Aim:The aim is to analyze the clinical features of drug-induced liver injury and autoimmune hepatitis and the response to hormones,providing a valuable experience for the accurate identification of DILI and AIH.Methods:In this paper,319 patients with DILI and 104 patients with AIH were enrolled in the Department of Hepatobiliary and Pancreatic Medicine of the First Hospital of Jilin University from January to February 2018,2013.Through statistical data analysis,the differences in gender,age,clinical symptoms,blood biochemical indicators,serum autoantibodies,immunological indicators,liver biopsy pathology and prognosis were compared between DILI group and AIH group,and DILI and AIH were constructed.Logistic regression model.In particular,the clinical data of 6 patients with DILI and the final diagnosis of DIAIH were analyzed,and the value of hormone response in the differential diagnosis of DILI and AIH was summarized.Results:1.The male-female ratio in the DILI group is about 1: 2.1,and the male-female ratio in the AIH group is about 1: 8.5.AIH is more common in women,and the difference is statistically significant(P <0.05);41 to 60 years old.2.The levels of WBC,PLT,ALT,AST,ALB,CHE,TBIL,and DBIL in the DILI group were higher than those in the AIH group,and the difference was statistically significant(P <0.05);the ALP level in the AIH group was higher than that in the DILI group The difference was statistically significant(P <0.05).There was no significant difference in the levels of EO,GGT,PT,and PTA between the two groups of patients(P> 0.05).The level of erythrocyte sedimentation in AIH group was higher than that in DILI group,and the difference was statistically significant(P <0.001).3.The ANA in AIH group was higher than that in DILI group at 1: 3200,1: 1000 and 1: 320,and the difference was statistically significant(P <0.05).The ANA in the DILI group was higher than that in the AIH group at 1: 100,and the difference was statistically significant(P <0.05).The positive rate of AMA in the AIH group was higher than that in the DILI group,and the difference was statistically significant(P <0.001).The positive rates of SMA,LKM,and SLA / LP in the AIH group were higher than those in the DILI group,and the differences were statistically significant(P <0.05).4.The levels of lgG,lgM,and lgA in the DILI group were lower than those in the AIH group,and the differences were statistically significant(P <0.001).The levels of serum lgG in the AIH group were 1.1-1.2 times,1.3-1.5 times,and 1.5 times more than those in the DILI group,and the differences were statistically significant(P <0.05).5.The incidence of lymphocyte infiltration,plasma cell infiltration,rosette structure,and fibrosis in the AIH group was greater than that in the DILI group,and the differences were statistically significant(P <0.05);the incidence of intrahepatic cholestasis in the DILI group was greater than AIH Group,the difference was statistically significant(P <0.05);interface inflammation was more common in patients in the AIH group and the DILI group,and the difference was not statistically significant(P> 0.05).6.39.42% of AIH patients with extrahepatic autoimmune disease,2.19% of DILI patients with extrahepatic autoimmune disease,the incidence of AIH combination with extrahepatic autoimmune disease was higher than that of DILI group,the difference was statistically significant(P <0.001).7.Construct a logistic regression model YGM that distinguishes between DILI and AIH.The optimal cutoff value for the model YGM to diagnose DILI and AIH is-0.57,with a specificity of 79.9% and a sensitivity of 76.7%.8.Six patients with first-diagnosis of DILI were given low-dose hormone therapy,and gradually reduced to discontinuation after remission.All patients relapsed after a follow-up of 5 to 15 months(median 5.5 months).The clinical data,pathological manifestations,and response to hormones were diagnosed as DIAIH,accounting for 5.8%(6/104)of all AIH cases.Conclusion:1.Both DILI and AIH occur in women,and the age of high incidence is 41 to 60 years.2.AIH often detects a variety of autoantibodies: ANA,AMA,SMA,LKM,and SLA / LP antibodies are positive,with high and medium titers;DILI has the highest probability of ANA,and low and medium titers Mainly.3.AIH has a higher probability than DILI combined with extrahepatic autoimmune diseases.Therefore,if patients with extrahepatic autoimmune diseases,AIH is more likely to be diagnosed.4.Patients with newly diagnosed DILI should be treated with glucocorticoids until the disease is relieved,and follow-up should be continued.If the disease recurs during the follow-up,it is most likely to be AIH.