肿瘤坏死因子α拮抗剂致自身免疫性肝炎的文献分析  

Literature review of autoimmune hepatitis induced by tumor necrosis factor-αantagonists

作　　者：赵啸虎 李永杰[2] 杨宏伟 张红梅[3] 李晓丹[4] 张敏 ZHAO Xiao-hu;LI Yong-jie;YANG Hong-wei;ZHANG Hong-mei;LI Xiao-dan;ZHANG Min(Jilin Institute for Drug Control,Changchun JILIN 130033,China;Department of Pharmacy,Songyuan Central Hospital,Songyuan JILIN 138000,China;Department of Pharmacy,Lequn Branch,the First Hospital of Jilin University,Changchun JILIN 130031,China;Department of Respiration,Lequn Branch,the First Hospital of Jilin University,Changchun JILIN 130031,China)

机构地区：[1]吉林省药品检验研究院,吉林长春130033 [2]松原市中心医院药剂科,吉林松原138000 [3]吉林大学第一医院乐群院区药学部,长春130031 [4]吉林大学第一医院乐群院区呼吸内科,吉林长春130031

出　　处：《中国新药与临床杂志》2024年第12期954-960,共7页Chinese Journal of New Drugs and Clinical Remedies

基　　金：吉林省科技厅项目(20210101289JC)。

摘　　要：目的探讨肿瘤坏死因子α(TNF-α)拮抗剂相关自身免疫性肝炎(AIH)的临床特点。方法检索中文和英文数据库,收集各数据库建库至2023年5月30日有关TNF-α拮抗剂引起AIH的相关文献,对患者的一般资料、用药信息、AIH症状、干预措施和转归等进行统计分析。结果共纳入患者44例,其中男性11例,女性33例,年龄(41.6±2.1)岁。77%的患者使用了英夫利昔单抗。19例患者描述了临床表现,包括腹痛(42%)、厌食(32%)、关节痛(26%)等。发生AIH后患者肝功能指标有不同程度的升高,免疫指标亦有升高或呈阳性,肝组织病理学检查主要表现为界面性肝炎(52%)、炎性浸润(50%)、肝细胞坏死(11%)等;停用TNF-α拮抗剂后转氨酶恢复正常中位时间为2(1,5)个月。结论TNF-α拮抗剂引起的AIH以英夫利昔单抗居多,好发于女性患者,多数患者转氨酶和免疫指标异常。临床使用TNF-α拮抗剂应注意监测,发生AIH后应予以停药,视病情给予糖皮质激素/硫唑嘌呤。AIM To explore the clinical characteristics of autoimmune hepatitis(AIH)induced by tumor necrosis factor-α(TNF-α)antagonists.METHODS Chinese and English databases were searched,and relevant literatures on AIH induced by TNF-αantagonist were collected until May 30,2023.The general data,medication information,AIH symptoms,intervention measures and outcomes of patients were statistically analyzed.RESULTS A total of 44 patients were included in the analysis,including 11 males and 33 females,with the age of(41.6±2.1)years.77%of patients used infliximab.Nineteen patients were described clinical manifestations,including abdominal pain(42%),anorexia(32%),arthralgia(26%),etc.After the occurrence of AIH,the liver function indexes increased in varying degrees,and the immune indexes also increased or positive.Liver biopsy showed interface hepatitis(52%),inflammatory infiltration(50%),hepatocyte necrosis(11%),etc.The median time for transaminase to return to normal after discontinuation of TNF-αantagonist was 2(1,5)months.CONCLUSION Infliximab is the most common cause of AIH induced by TNF-αantagonists,and it is most common in female patients.Most patients have abnormal transaminase and immune indexes,attention should be paid to monitoring the clinical use of TNF-αantagonists.After AIH,TNF-αantagonists should be discontinued and glucocorticoid or azathioprine should be given depending on the condition.

关 键 词：肿瘤坏死因子α拮抗剂 自身免疫性肝炎 英夫利昔单抗 阿达木单抗 依那西普 

分 类 号：R969.3[医药卫生—药理学] R979.5[医药卫生—药学]