| Object: In recent years,the incidence rate of liver injury caused by drugs is increasing.Clinically,autoimmune hepatitis induced by drugs(DIAIH)and drug-induced liver injury(DILI)are common.What’s more,the characteristics of DIAIH are very similar to DILI and AIH,which is greatly difficult to diagnose differentially for clinicians.But the early diagnosis not only can provide the correct treatment of the disease but also effectively prevent the progress of the disease and improve the prognosis.Therefore,this study aims to analyze the other clinical differences of DIAIH,DILI and AIH besides autoimmune antibodies and pathological tissues known at present,which provide more clinical ideas for early differential diagnosis of DIAIH.Methods: Collected the clinical data of patients with DIAIH,DILI and AIH,who were diagnosed in our hospital(First Affiliated Hospital of Shihezi University)from December 2014 to June 2020.There may be some differences via retrospective analysis among the patients between DIAIH group and DILI group,DIAIH group and AIH group,such as the onset age,gender,medication history,main clinical symptoms at first visit,biochemical indexes(including ALT,AST,ALP,GGT,TBIL,DBIL,IBIL,G,TBA),peripheral blood leukocyte count and classification indexes(including WBC,N,L,M,E,B)and extrahepatic autoimmune diseases.Results: 1.General data: A total of 14 patients with DIAIH were included,including 9 females and 5males;135 patients with DILI,including 68 females and 67 males;50 patients with AIH,35 females and 15 males.In terms of gender,female patients in DIAIH group and AIH group were more common,however,male and female patients accounted for about 50% in DILI group.There was no significant difference between DIAIH group and DILI group,DIAIH group and AIH group(all P > 0.05).2.The age characteristics of patients: The average age of onset in DIAIH group was 61.50±15.28 years old,and that with high incidence was over 55 years old,accounting for 78.6%;The average age of onset in DILI group was 51.96 ± 16.85 years old,and that in AIH group was 57.36 ± 12.92 years old,and that with high incidence was 40-55 years old,accounting for 44.4% and 50.0%,respectively.After statistical analysis,it was found that the DIAIH group was larger than the DILI group(P < 0.05),but there was no significant difference between DIAIH group and AIH group(P > 0.05).3.The types of drugs that induce diseases:This group of data showed that there were fewer types of drugs inducing DIAIH,with Chinese herbal medicine accounting for the largest proportion,followed by statins lipid-lowering drugs and antibacterial drugs.There were many types of drugs inducing DILI,the first is Chinese herbal medicine,the second is antimicrobial drugs,and the third is anti-tuberculosis drugs.4.Clinical symptoms: In terms of this group of data,the main clinical symptoms of DIAIH group,DILI group and AIH group were fatigue,anorexia,yellow staining of skin mucosa and sclera,abdominal pain,abdominal distension,and urine yellow.The frequency of extrahepatic system manifestations(rash,pruritus,edema of lower limbs)in DILI group was higher than that in DIAIH group and AIH group,while asymptomatic abnormal liver function was most common in AIH group.5.Serum biochemical analysis: Compared with DILI group,the serum GGT,G and TBA levels of DIAIH group were more significantly increased at the first visit(all P <0.05),there were no significant differences in ALT,AST,ALP,TBIL,DBIL and IBIL levels between the two groups(all P>0.05).Compared with AIH group,the serum ALT and AST levels of DIAIH group were more significantly increased,while the serum ALP level was opposite(all P<0.05),there were no significant differences in the levels of TBIL,DBIL,IBIL,GGT,G and TBA between the two groups(all P>0.05).6.Serum white blood cells and their classification: Compared with DIAIH group and DILI group,DIAIH group and AIH group,there was no statistically significant difference in blood WBC,N,L,M,E,B levels(all P > 0.05).7.Complicati-ons of extrahepatic autoimmune diseases: In the data of this study,the prevalence of immune diseases of other extrahepatic systems in the combination of DIAIH,DILI and AIH was respectively 7.1%,5.2% and 18.0%,and there was no statistical significances between DIAIH group and DILI group,DIAIH group and AIH group(all P>0.05).Conclusion: 1.DIAIH mainly occurs in middle-aged and elderly women and may also be associated with extrahepatic autoimmune diseases.2.Chinese herbal medicine are the most common drugs inducing DIAIH.3.At the initial visit,the levels of serum GGT,G and TBA of DIAIH group was higher than that in the DILI patients,the level of serum ALT and AST was higher than that in the AIH patients,but the ALP was lower,which may provide clues for the differential diagnosis of DIAIH and DILI and AIH. |
