The Clinical And Pathological Study On Drug-induced Autoimmune Hepatitis

Background and AimsSeveral drugs have been recognized as causes of drug-inducedautoimmune hepatitis (DIAIH), however, distinguishing DIAIH fromidiopathic autoimmune hepatitis (AIH) is still challenging. The aims offthis study were to evaluate the clinical and pathological characteristics ofDIAIH and to explore the difference between DIAIH and AIH.MethodsPatients who had suffered from DIAIH and AIH between March2004and May2014were analyzed retrospectively. Patients who hadundergone liver biopsy between March and May2014in First Hospitalof Jilin University were analyzed retrospectively. The patients in thisstudy were diagnosed with DIAIH and AIH according to the diagnosticscoring system of the International Autoimmune Hepatitis Group in1999.Some specific cases will be excluded from this study. Such as overlapsyndromes, viral hepitis and metaolic disease. Clinical and laboratorydata was collected and liver histopathological features of DIAIH andAIH were analysed in these patients. The treatment and prognosis ofpatients were followed up.ResultsOf49patients,14patients (28.6%) was diagnosed with AIH,35patients (71.4%) were diagnosed with DIAIH. All patients with DIAIHwere females with a median age of52(interquartile range,44-57). The most frequent cause of DIAIH was herbal medicine. The main clinicalmanifestations of patients with DIAIH were nausea, vomiting, anorexia,right upper abdominal discomfort. Some DIAIH patients presented withextrahepatic manifestations, such as arthritis, atopic dermatitis. Elevatedserum ALT, AST,globulin and IgG levels were determined in all of thesepatients. All DIAIH patients (35/35) was positive for antinuclearantibodies and14.2%of patients (5/35) was positive for smooth muscleantibodies. Some of the share histological features for DIAIH and AIHwere potal inflammation with lymphocyte infiltration and were hepaticfibrosis. Bridge necrosis was found to be more frequent in AIH patientsthan in patients with DIAIH, whereas, spotty necrosis was more frequentin DIIAH than AIH (p<0.01,p<0.05). Hepatocyte degeneration (hydrofic,blooning, acidophilic degeneration and hepatocelluar cholestasis) wasfound to be more frequent and more severe in DIAIH patients thanpatients with AIH (p<0.05,p<0.05,p<0.01,p<0.01). The infiltration ofplasmacyte and eosinophils and the proliferation of bile duct in portaltract area were more severe in DIAIH than AIH (p<0.05, p<0.01,p<0.05).ConclusionAlthough there were some common features in DIAIH and AIH, thehistological difference between two diseases has been recognized.Therefore, it is practicable for hepatologist and pathologist to make acorrect diagnosis of DIAIH.