Analysis Of Clinical Features Of Drug-induced Liver Injury With Positive Antinuclear Antibody

Objective:Drug-induced liver injury can be accompanied by positive autoantibody,with the highest detection rate of ANA.Whether ANA plays a role in DILI is controversial.Methods:From January 2015 to December 2021,we collected data from 519 patients who were hospitalized in the Department of Hepatobiliary and Pancreatic Medicine of our hospital and diagnosed with"drug-induced liver injury"and"drug-induced liver failure"based on medical history or liver tissue biopsy,and screened 519 patients with DILI.SPSS26.0 statistical software was applied to analyze the data.Results:1.Analysis of overall clinical characteristics of DILI.Among the 519 patients with DILI,382 were female and 137 were male,with a male-to-female ratio of 1:3.6 and a median age of 51 years.The drugs causing DILI were mainly herbal drugs,followed by combination drugs and antipyretic and analgesic drugs.The median time from initiation of medication to clinical symptoms was 30 days,the median time of medication administration was 30 days,and the median time of hospitalization was 15 days.The most frequent clinical symptoms in DILI patients were yellow staining of skin and sclera,followed by malaise and dyspareunia.6.9%of DILI patients had combined autoimmune underlying diseases,among which rheumatoid arthritis and dry syndrome were common.8.9%of DILI patients had previous In 61.8%of DILI patients,61.8%of DILI patients tested positive for ANA,with titer 1:100 being the most common.The hepatocellular type was the most common type of liver injury.180 patients with DILI were treated with glucocorticoid therapy,and the prognosis of DILI patients was good after discontinuation and treatment,with treatment efficacy and efficiency of 90.2%.The most common pathological changes in patients with DILI are interstitial plasma cell infiltration,mild dilatation of the confluent area,mild fibrosis in the confluent area,Kupffer cell proliferation in the hepatic sinusoids,hepatocyte punctate necrosis,and interstitial eosinophil infiltration.The most common grade of inflammation was G₃and the most common stage of fibrosis was S₁.Some patients with DILI have AIH-like pathological histological changes,most commonly lymphoplasmacytic infiltration in the confluent area,followed by interfacial inflammation.2.Comparison of clinical features between the ANA-negative and ANA-positive groups of DILI patients.Compared with the ANA-negative group,patients in the ANA-positive group had higher median age,a higher proportion of females,more clinical manifestations of jaundice and dysphagia,and a higher proportion of combined autoimmune underlying diseases.The proportion of liver pathological histological changes with acid granulocyte infiltration,moderate to severe infiltration of interstitial lymphocytes,G≥grade 3,and S≥stage 3was higher than that of patients in the ANA-negative group.patients with DILI in the ANA-positive group had higher levels of AST,ALP,GLO,TBIL,DBIL,TBA,RDW,PT,Ig G,Ig A,and Ig M,but CHE,ALB,serum complement C3 and C4 levels were lower.The ANA-positive group of DILI patients had a more severe liver injury,higher MELD score,and lower LMR at the time of admission.Patients in the ANA positive group had a longer hospital stay and a higher rate of hormonal therapy,and there was no significant difference in the effectiveness or significant efficiency of hospitalization between the two groups.Conclusions.1,Patients with DILI are predominantly female,herbal medicine is the main causative agent,and hepatocellular type is the most common subtype.2,The main pathological histological changes of DILI were punctate necrosis of hepatocytes,the proliferation of Kupffer cells in the hepatic sinusoids,mild dilatation,and fibrosis in the confluent area,mild hyperplasia of small bile ducts,and infiltration of plasma cells and eosinophils in the interstitium.3,61.8%of DILI patients were positive for ANA,with a titer of 1:100 being the most common.4,Compared with the ANA-negative group,DILI patients in the ANA-positive group was older,the proportion of females was higher,the degree of liver injury was heavier,the liver synthesis function was poorer,the inflammation and necrosis were obvious in histopathology,and the degree of fibrosis was higher.After treatment,the prognosis of the two groups was good but there was no significant difference.