Department of Internal Medicine, Section of Gastroenterology and Hepatology, Landspitali University Hospital, Reykjavik, Iceland.
Hepatology. 2010 Jun;51(6):2040-8. doi: 10.1002/hep.23588.
Drug-induced autoimmune hepatitis (DIAIH) has been reported to be caused by several drugs. There is a lack of data comparing these patients with other patients with autoimmune hepatitis (AIH). A search was performed using the Mayo Clinic diagnostic medical index for AIH patients and DIAIH patients identified over 10 years. Individuals with overlap syndromes and decompensated liver disease were excluded. Overall, 261 patients (204 females, median age 52) were identified, and 24 (9.2%) were DIAIH cases with a median age of 53 (interquartile range, 24-61). Two drugs, nitrofurantoin (n = 11) and minocycline (n = 11), were the main causes. A similar proportion of DIAIH patients had positive antinuclear antibodies (83% versus 70%) and smooth muscle antibodies (50% versus 45%) as compared with AIH patients. Histological grade and stage were similar in patients with DIAIH versus AIH; however, none of the DIAIH patients had cirrhosis at baseline; this was present in 20% of matched AIH cases. Liver imaging was normal in all minocycline cases. Eight of 11 (73%) nitrofurantoin patients had abnormalities on hepatic imaging (mainly liver atrophy), a finding seen in only 8 of 33 (24%) of a random sample of the rest of the AIH group (P = 0.0089). Corticosteroid responsiveness was similar in DIAIH and the AIH patients. Discontinuation of immunosuppression was tried and successful in 14 DIAIH cases, with no relapses (0%), whereas 65% of the AIH patients had a relapse after discontinuation of immunosuppression (P < 0.0001).
A significant proportion of patients with AIH have drug-induced AIH, mainly because of nitrofurantoin and minocycline. These two groups have similar clinical and histological patterns. However, DIAIH patients do not seem to require long-term immunosuppressive therapy.
据报道，药物性自身免疫性肝炎（DIAIH）由几种药物引起。目前缺乏将这些患者与其他自身免疫性肝炎（AIH）患者进行比较的数据。使用梅奥诊所的 AIH 患者和 10 多年来发现的 DIAIH 患者的诊断医学索引进行了搜索。排除重叠综合征和肝功能失代偿的个体。总共确定了 261 名患者（204 名女性，中位年龄 52 岁），其中 24 名（9.2%）为 DIAIH 病例，中位年龄为 53 岁（四分位距，24-61）。两种药物，呋喃妥因（n = 11）和米诺环素（n = 11）是主要原因。与 AIH 患者相比，DIAIH 患者的抗核抗体阳性率（83%比 70%）和平滑肌抗体阳性率（50%比 45%）相似。DIAIH 患者与 AIH 患者的组织学分级和分期相似；然而，在基线时，没有 DIAIH 患者患有肝硬化，而在匹配的 AIH 病例中，有 20%的患者患有肝硬化。米诺环素的所有病例肝脏影像学均正常。11 例硝基呋喃妥因患者中有 8 例（73%）肝脏影像学异常（主要为肝萎缩），在随机抽取的其余 33 例 AIH 患者中，只有 8 例（24%）有此发现（P = 0.0089）。DIAIH 和 AIH 患者的皮质类固醇反应性相似。在 14 例 DIAIH 病例中尝试并成功停用免疫抑制剂，无复发（0%），而在停用免疫抑制剂后，65%的 AIH 患者复发（P < 0.0001）。
相当一部分 AIH 患者患有药物性 AIH，主要是由于呋喃妥因和米诺环素。这两组具有相似的临床和组织学模式。然而，DIAIH 患者似乎不需要长期免疫抑制治疗。
