Kuzu Ufuk Bariş, Öztaş Erkin, Turhan Nesrin, Saygili Fatih, Suna Nuretdin, Yildiz Hakan, Kaplan Mustafa, Akpinar Muhammet Yener, Akdoğan Meral, Kaçar Sabite, Kiliç Zeki Mesut Yalin, Köksal Aydin Şeref, Ödemiş Bülent, Kayaçetin Ertuğrul
Departments of Gastroenterology, Ankara, Turkey.
Pathology, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
Hepatol Res. 2016 Apr;46(4):277-91. doi: 10.1111/hepr.12530. Epub 2015 May 21.
Drug-induced liver injury (DILI) is becoming a worldwide problem with its still unexplained properties.
The data of patients who were diagnosed with DILI between January 2008 and December 2013 were assessed.
Five patients had been diagnosed with intrinsic and 82 patients with idiosyncratic DILI. The most common causative agents were antimicrobial drugs. The most common injury pattern was hepatocellular. When patients with bilirubin levels of more than 5 mg/dL were divided into two groups according to receiving steroid therapy (n = 11) or not (n = 40), there was not any significant difference according to their clinical results (P > 0.05). Five of the idiosyncratic DILI patients were diagnosed with drug-induced autoimmune hepatitis (DI-AIH). In histopathological examination, hepatic rosette formation and emperipolesis were observed to be more common among patients with DI-AIH when compared with ones without (P < 0.05). Interestingly, in the remaining patients with DILI (n = 77), three of them were diagnosed with classic autoimmune hepatitis during long-term follow up (range, 11-51 months).
The most common causes were antimicrobials, but any agents that have not been defined to cause DILI can induce DILI. The efficacy of steroids in DILI has not been observed but all deaths were observed in the steroid-free group. The association of DILI and AIH was observed in two different types in terms of diagnosis in our study. The first association was DI-AIH. The second one is the classical AIH which developed in three patients after a few months following spontaneous recovery of DILI.
药物性肝损伤（DILI）正成为一个全球问题，其特性仍未完全明确。
对2008年1月至2013年12月期间诊断为DILI的患者数据进行评估。
5例患者被诊断为固有型DILI，82例为特异质型DILI。最常见的致病药物是抗菌药物。最常见的损伤类型是肝细胞损伤。将胆红素水平超过5mg/dL的患者根据是否接受类固醇治疗分为两组（n = 11）或未接受组（n = 40），根据临床结果无显著差异（P>0.05）。5例特异质型DILI患者被诊断为药物性自身免疫性肝炎（DI-AIH）。在组织病理学检查中，与未患DI-AIH的患者相比，DI-AIH患者中肝玫瑰花结形成和血细胞吞噬现象更为常见（P<0.05）。有趣的是，在其余DILI患者（n = 77）中，其中3例在长期随访（11 - 51个月）期间被诊断为经典自身免疫性肝炎。
最常见的病因是抗菌药物，但任何未被明确可导致DILI的药物都可能诱发DILI。未观察到类固醇在DILI中的疗效，但所有死亡病例均出现在未使用类固醇的组中。在我们的研究中，从诊断角度观察到DILI与AIH存在两种不同类型的关联。第一种关联是DI-AIH。第二种是在DILI自发恢复几个月后3例患者中出现的经典AIH。
