Licata Anna, Maida Marcello, Cabibi Daniela, Butera Giuseppe, Macaluso Fabio S, Alessi Nicola, Caruso Calogero, Craxì Antonio, Almasio Piero L
Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
Section of Gastroenterology, Di.Bi.M.I.S., University of Palermo, Italy.
Dig Liver Dis. 2014 Dec;46(12):1116-20. doi: 10.1016/j.dld.2014.08.040. Epub 2014 Sep 16.
Drugs and herbal products can induce autoimmune hepatitis. We assessed frequency and clinical outcomes of patients suffering from drug-induced autoimmune hepatitis.
All patients with drug-induced liver injury admitted between 2000 and 2011 were retrospectively studied. Diagnoses of drug-induced autoimmune hepatitis and idiopathic autoimmune hepatitis were made according to simplified criteria. After discharge, all patients had regular follow-up and were contacted to update outcomes.
Among 10,270 in-hospital patients, 136 (1.3%) were diagnosed with drug-induced liver injury. Among them, 12 (8.8%) were diagnosed as drug-induced autoimmune hepatitis (41.7% males, age range 17-73); 8 (66.7%) were with jaundice at admission. Liver biopsies showed a pattern compatible with drug-induced autoimmune hepatitis, featured by severe portal inflammation and lymphoplasmacytic infiltrate. Drug-induced autoimmune hepatitis group had a shorter duration of drug intake, and higher values of transaminases and gamma globulins. All patients received immunosuppressive therapy with subsequent clinical remission, and five achieved a steroid-free long-term remission.
A diagnosis of drug-induced autoimmune hepatitis was quite rare in our cohort, and clinical pattern was similar to idiopathic autoimmune hepatitis. Severe portal inflammation, prominent portal-plasma cells, rosette formation and severe focal necrosis were significantly more frequent in drug-induced autoimmune hepatitis as compared to drug-induced liver injury.
药物和草药产品可诱发自身免疫性肝炎。我们评估了药物性自身免疫性肝炎患者的发病率及临床结局。
对2000年至2011年间收治的所有药物性肝损伤患者进行回顾性研究。根据简化标准诊断药物性自身免疫性肝炎和特发性自身免疫性肝炎。出院后，所有患者均接受定期随访并联系以更新结局。
在10270例住院患者中，136例（1.3%）被诊断为药物性肝损伤。其中，12例（8.8%）被诊断为药物性自身免疫性肝炎（男性占41.7%，年龄范围17 - 73岁）；8例（66.7%）入院时伴有黄疸。肝活检显示符合药物性自身免疫性肝炎的模式，以严重的门脉炎症和淋巴浆细胞浸润为特征。药物性自身免疫性肝炎组的用药时间较短，转氨酶和γ球蛋白值较高。所有患者均接受免疫抑制治疗，随后临床缓解，5例实现了无类固醇的长期缓解。
在我们的队列中，药物性自身免疫性肝炎的诊断相当罕见，其临床模式与特发性自身免疫性肝炎相似。与药物性肝损伤相比，药物性自身免疫性肝炎中严重的门脉炎症、显著的门脉浆细胞、玫瑰花结形成和严重的局灶性坏死更为常见。
