Clinical characteristics of drug-induced autoimmune hepatitis / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To investigate the clinical characteristics of drug-induced autoimmune hepatitis(DIAIH), in order to help clinicians learn more about DIAIH and improve its clinical diagnosis. METHODS: This was a retrospective study in the patients with DIAIH and DILI treated at Shengjing Hospital of China Medical University between January 2013 and December 2017. The population characteristic,related drugs,clinical manifestations,liver biochemical parameters, autoimmune antibodies, and liver pathological features were compared between the two groups. RESULTS: There were 49 patiens with DIAIH and 436 patiens with DILI. The majority of these patients were female. There was a significant difference in the proportion of female patients, with DIAIH(91.84%, 45/49)higher than DILI(70.41%, 307/436)(χ~2=9.111, P=0.003). The patients with DIAIH had a mean age of(50.0±7.4) years. The top three drugs inducing DIAIH were Chinese herbal medicines(53.06%, 26/49), non-steroidal anti-inflammatory drugs(10.20%, 5/49) and fluvastatin(10.20%, 5/49). DIAIH occurred after more than 8 weeks of treatment. There was a significant difference in the proportion of liver failure, with DIAIH(30.61%, 15/49) higher than DILI(14.68%, 64/436)(χ~2=8.20, P=0.004). The risks of DIAIH and DILI with liver failure caused by western medicines were significantly higher than those by Chinese herbal medicines(χ~2=9.77, P=0.002; χ~2=16.09,P<0.001). The positive rate of autoimmune antibody in DIAIH patients was 100%. The positive rate of ANA was 83.67%(41/49), and that of SMA was 16.33%(8/49). The liver pathological features of interface hepatitis, plasma cells and lymphocytes infiltration in DIAIH patients were more obvious than those in DILI patients. CONCLUSION: DIAIH is more common in the female patients and is caused frequently by Chinese herbal medicines. DIAIH caused by western medicines could easily result in liver failure.