Clinical Analysis Of Patients With Non-Hepatogenic Autoimmune Liver Injury

Background:Non-hepatogenic autoimmune liver injury(N-HALI)refers to immune-mediated liver injury excluding autoimmune hepatitis,primary biliary cirrhosis,primary sclerosing cholangitis,Immunoglobulin G4-related cholangitis and overlap syndrome with each other.At present,there are many reports about liver injury caused by certain autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis.NHALI has not been entitled as an independent disease,but as one of the common causes of liver injury clinically,its importance cannot be ignored.Objective:To summarize the clinical features of NHALI and to improve the understanding of this kind of disease.Methods:Clinical data of patients from January 1st,2017 to December 31 st,2019 in Qilu hospital was collected,who was primarily diagnosed as extrahepatic autoimmune diseases like systemic lupus erythematosus and rheumatoid arthritis,secondarily diagnosed as liver injury,liver damage or liver dysfunction,older than 16 years old and whose liver injury was not triggered by definite causes.The main collected materials include:age,gender,clinical manifestation,primary disease,laboratory examination,medication and outcome.Types of liver injury and severity were also analysed.Results:The diseases leading to NHALI include systemic lupus erythematosus,rheumatoid arthritis,systemic vasculitis,primary sjogren's syndrome,dermatomyositis,ankylosing spondylitis,etc.Among them systemic lupus erythematosus,rheumatoid arthritis and dermatomyositis are most common.NHALI is more likely to occur in females.The type of liver injury had no specificity with liver biochemistry abnormality mainly and the severity classification was mostly mild.In addition to the clinical manifestations of the primary disease,most of patients were accompanied by non-specific symptoms such as anorexia and fatigue,and the clinical manifestations such as jaundice and right upper abdomen pain were rare.The degree of liver damage was positively correlated with the severity and activity of the primary disease.The majority of patients would recover after active treatment of the primary disease and liver protection therapy.Conclusion:Autoimmune liver injury caused by extrahepatic organ or systemic diseases cannot be neglected.Almost all autoimmune diseases outside the liver have the risk of liver damage.As a clinician,we should pay more attention to liver injury from extrahepatic organs in the face of liver function damage with unclear reasons.In NHALI patients,liver lesions are secondary and the degree of liver impairment is usually mild.The vast majority of NHALI patients are female.After the treatment of underlying diseases and the administration of appropriate liver protection drugs,the liver function can be reduced.Clinicians should strengthen in the distinguishment between NHALI and other types of liver damage,including autoimmune liver disease,infection of HBV,nonalcoholic fatty liver disease,drug-induced liver injury,and alcoholic liver disease.