药物性肝损伤患者血清抗核抗体阳性临床意义探讨  

Clinical feature of patients with serum anti-nuclear antibody positive drug-induced liver injury

作　　者：潘劲劲 谢琴秀[1] 许夕海[1] 郜玉峰[1] 李家斌[1] Pan Jinjin;Xie Qinxiu;Xu Xihai(Department of Infectious Diseases,First Affiliated Hospital,Anhui Medical University,Hefei 230022,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院感染病科,合肥市230022

出　　处：《实用肝脏病杂志》2024年第4期543-546,共4页Journal of Practical Hepatology

基　　金：安徽省高校(专业)拔尖人才学术研究基金资助重点项目(编号:gxbjZD08)。

摘　　要：目的分析不同临床类型和血清抗核抗体(ANA)阳性的药物性肝损伤(DILI)患者临床特征和转归。方法2019年12月~2023年4月安徽医科大学第一附属医院感染病科诊治的DILI患者64例,均行肝活检术和常规血清检测,排除自身免疫性肝炎(AIH)。其中血清ANA阳性31例,ANA阴性33例。结果在本组64例DILI患者中,导致疾病的药物为中草药占59.4%,抗生素占10.9%和非甾体类药物占4.7%;肝细胞型42例(65.6%),胆汁淤积型11例(17.2%)和混合型11例(17.2%);ANA阳性组肝细胞型、胆汁淤积型和混合型分别占77.4%、6.5%和16.1%,而ANA阴性组分别为54.5%、5.2%和30.3%,无统计学差异(P>0.05);ANA阳性组血清球蛋白和Ig G水平分别为26.1(22.2,29.9)g/L和13.6(12.1,17.7)g/L,显著高于ANA阴性组【分别为22.9(21.6,25.2)g/L和11.5(9.4,12.9)g/L,P<0.05】;两组所有患者均获得肝功能指标恢复正常,其中在31例ANA阳性DILI患者中,1例最终导致药物诱自身免疫性肝炎(DI-AIH),2例考虑为免疫介导的药物性肝损伤(IM-DILI),这3例患者均加用糖皮质激素治疗后,血清ALT和AST水平恢复正常。结论大多DILI患者预后良好,但血清ANA阳性者可能发展至DI-AIH或IM-DILI,需加用皮质激素治疗,值得注意。Objective The aim of this study was to summarize clinical feature of patients with serum anti-nuclear antibody(ANA)positive drug-induced liver injury(DILI).Methods 64 patients with DILI were admitted to the First Affiliated Hospital,Anhui Medical University between December 2019 and April 2023,and all patients underwent liver biopsies to exclude autoimmune hepatitis(AIH).Serum ANA was found positive in 31 patients and negative in 33 patients.Results Of the 64 patients with DILI,the blamed medicines included herbal medicine in 59.4%,antibiotics in 10.9%and nonsteroidal antiinflammatory drugs in 4.7%;the hepatocellular injury type accounted for 65.6%,cholestatic type for 17.2%and mixed type for 17.2%;of patients with serum ANA positive,the hepatocellular injury type,cholestatic type and mixed type accounted for 77.4%,6.5%and 16.1%,not significantly different as compared to 54.5%,5.2%and 30.3%in those with serum ANA negative(P>0.05);serum globulin and Ig G levels in DILI patients with serum ANA positive were 26.1(22.2,29.9)g/L and 13.6(12.1,17.7)g/L,both significantly higher than[22.9(21.6,25.2)g/L and 11.5(9.4,12.9)g/L,respectively,P<0.05]in those with serum ANA negative;all patients in the two groups recovered,except for one in serum ANA positive group,who ultimately transferred to drug-induced autoimmune hepatitis(DI-AIH)and two also with serum ANA positive,who transferred to immune mediated drug-induced liver injury(IM-DILI),and the three patients got their liver function tests recovered after oral steroid administration.Conclusion DILI patients with serum ANA positive could recover smoothly,some of them might switch to DI-AIH or IM-DILI,and needs steroid therapy.

关 键 词：药物性肝损伤 抗核抗体 临床特征 预后 

分 类 号：R575[医药卫生—消化系统]