Hassoun Jeremy, Goossens Nicolas, Restellini Sophie, Ramer Lucas, Ongaro Marie, Giostra Emiliano, Hadengue Antoine, Rubbia-Brandt Laura, Spahr Laurent
Department of Gastroenterology and Hepatology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland.
Department of Clinical Pathology University Hospitals of Geneva and Faculty of Medicine Geneva Switzerland.
JGH Open. 2023 Jan 11;7(2):135-140. doi: 10.1002/jgh3.12862. eCollection 2023 Feb.
Drug-induced liver injury (DILI) may present with autoimmune features and require immunosuppressive therapy (IST) to reach biochemical response. Discontinuation of IST without hepatitis relapse may be more frequent in these patients as compared to patients with classical autoimmune hepatitis (AIH). We aimed to determine baseline characteristics and outcome of patients with immune-mediated drug induced liver injury (IMDILI) with particular emphasis on IST during follow-up.
We performed a single-center retrospective study of consecutive patients presenting at a tertiary care center between January 2005 and December 2019 either with IMDILI or with classical AIH, for whom full baseline characteristics and a close follow-up were available over a 12-month period.
Overall, 31 patients (IMDILI = 16, mean age 59 [34-74] years; AIH = 15, mean age 47 [15-61] years) were included, showing similar biochemical, serological, and histological characteristics. Incriminating drugs in IMDILI patients were mostly represented by nonsteroidal antiinflammatory drugs and sartans. Initial corticosteroids combined with IST led to biochemical response in all patients. Compared to idiopathic AIH, more patients with IMDILI were weaned off corticosteroids at the end of follow-up (11/16 [68.7%] 4/15 [26.6%], < 0.02). At 1 year of follow-up, more patients in the IMDILI group compared to the classical AIH group were off any type of IST (13/16 [81%] 15/15 [100%], = 0.08).
Although presenting with similar baseline biochemical and histological characteristics as idiopathic AIH, patients with IMDILI may not require long-term IST.
药物性肝损伤（DILI）可能表现出自身免疫特征，需要免疫抑制治疗（IST）以实现生化反应。与经典自身免疫性肝炎（AIH）患者相比，这些患者在无肝炎复发的情况下停用IST可能更为常见。我们旨在确定免疫介导的药物性肝损伤（IMDILI）患者的基线特征和结局，特别关注随访期间的IST情况。
我们对2005年1月至2019年12月期间在一家三级医疗中心就诊的连续患者进行了单中心回顾性研究，这些患者患有IMDILI或经典AIH，在12个月期间可获得完整的基线特征和密切随访资料。
总共纳入了31例患者（IMDILI = 16例，平均年龄59 [34 - 74]岁；AIH = 15例，平均年龄47 [15 - 61]岁），显示出相似的生化、血清学和组织学特征。IMDILI患者中导致肝损伤的药物主要是非甾体类抗炎药和沙坦类药物。初始使用皮质类固醇联合IST使所有患者实现了生化反应。与特发性AIH相比，更多IMDILI患者在随访结束时停用了皮质类固醇（11/16 [68.7%]比4/15 [26.6%]，P < 0.02）。在随访1年时，与经典AIH组相比，IMDILI组更多患者停用了任何类型的IST（13/16 [81%]比15/15 [100%]，P = 0.08）。
尽管IMDILI患者的基线生化和组织学特征与特发性AIH相似，但可能不需要长期IST。
