Yang Jun, Yu Ya-Li, Jin Yu, Zhang Ying, Zheng Chang-Qing
Jun Yang, Ya-Li Yu, Yu Jin, Ying Zhang, Chang-Qing Zheng, Division II, Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang 110024, Liaoning Province, China.
World J Gastroenterol. 2016 Sep 7;22(33):7579-86. doi: 10.3748/wjg.v22.i33.7579.
To summarize and compare the clinical characteristics of drug-induced liver injury (DILI) and primary biliary cirrhosis (PBC).
A total of 124 patients with DILI and 116 patients with PBC treated at Shengjing Hospital Affiliated to China Medical University from 2005 to 2013 were included. Demographic data (sex and age), biochemical indexes (total protein, albumin, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, and gamma glutamyltransferase), immunological indexes [immunoglobulin (Ig) A, IgG, IgM, antinuclear antibody, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-mitochondrial antibodies] and pathological findings were compared in PBC patients, untyped DILI patients and patients with different types of DILI (hepatocellular type, cholestatic type and mixed type).
There were significant differences in age and gender distribution between DILI patients and PBC patients. Biochemical indexes (except ALB), immunological indexes, positive rates of autoantibodies (except SMA), and number of cases of patients with different ANA titers (except the group at a titer of 1:10000) significantly differed between DILI patients and PBC patients. Biochemical indexes, immunological indexes, and positive rate of autoantibodies were not quite similar in different types of DILI. PBC was histologically characterized mainly by edematous degeneration of hepatocytes (n = 30), inflammatory cell infiltration around bile ducts (n = 29), and atypical hyperplasia of small bile ducts (n = 28). DILI manifested mainly as fatty degeneration of hepatocytes (n = 15) and spotty necrosis or loss of hepatocytes (n = 14).
Although DILI and PBC share some similar laboratory tests (biochemical and immunological indexes) and pathological findings, they also show some distinct characteristics, which are helpful to the differential diagnosis of the two diseases.
总结并比较药物性肝损伤（DILI）和原发性胆汁性肝硬化（PBC）的临床特征。
纳入2005年至2013年在中国医科大学附属盛京医院接受治疗的124例DILI患者和116例PBC患者。比较PBC患者、未分型DILI患者及不同类型DILI（肝细胞型、胆汁淤积型和混合型）患者的人口统计学数据（性别和年龄）、生化指标（总蛋白、白蛋白、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、直接胆红素、间接胆红素、碱性磷酸酶和γ-谷氨酰转移酶）、免疫指标[免疫球蛋白（Ig）A、IgG、IgM、抗核抗体、抗平滑肌抗体、抗线粒体抗体及抗线粒体抗体亚群]以及病理结果。
DILI患者和PBC患者在年龄和性别分布上存在显著差异。DILI患者和PBC患者在生化指标（除ALB外）、免疫指标、自身抗体阳性率（除SMA外）以及不同ANA滴度患者的病例数（除滴度为1:10000的组外）方面存在显著差异。不同类型DILI的生化指标、免疫指标和自身抗体阳性率不太相似。PBC的组织学特征主要为肝细胞水肿变性（n = 30）、胆管周围炎性细胞浸润（n = 29）和小胆管非典型增生（n = 28）。DILI主要表现为肝细胞脂肪变性（n = 15）和肝细胞点状坏死或缺失（n = 14）。
尽管DILI和PBC在一些实验室检查（生化和免疫指标）及病理结果上有相似之处，但它们也表现出一些不同特征，这有助于两种疾病的鉴别诊断。
