Control Analysis Of Autoantibody-positive Chinese And Western Drug-induced Liver Injury And Study Of Autoantibody Negative Factors

Objectives1 To explore the differences in clinical features and prognosis of drug-induced liver injury(DILI)with positive-autoantibody caused by traditional Chinese medicine(TCM)and western medicine(WM).2 To investigate the influence factors of autoantibody turned negative within six months in DILI patients with positive-autoantibody.Methods1 A total of 2051 patients diagnosed as DILI were enrolled from Beijing Ditan Hospital Affiliated to Capital Medical University from August 2008 to June 2017.According to the inclusion and exclusion criteria,290 cases with autoantibody-positive caused by traditional Chinese medicine or western medicine that meet the requirements of this study were continuously included,and were classified into two groups according to the suspicious drugs that induced liver injury(patients used traditional Chinese medicine were classified into TCM group;patients used western medicine were classified into WM group).And comparing the differences in clinical characteristics and prognosis between the two groups.2 A total of 2051 patients diagnosed as DILI were enrolled from Beijing Ditan Hospital Affiliated to Capital Medical University from August 2008 to June 2017.According to the inclusion and exclusion criteria,168 DILI patients with autoantibody-positive that meet the requirements of this study were continuously included.The baseline date was set as the time when patients were firstly diagnosed as DILI,each patient were followed up for six months.Collecting clinical data of each patients at baseline and after six months.According to the condition of autoantibodies after six months,the patients were divided into two groups(patients with autoantibodies all turned negetive were classified into negetive group,others were classfied into positive-autoantibody group),then research the independent influence factors of autoantibody turned negetive within six months by COX regression univariate and multivariate analysis.Results1 Among the,290 DILI patients with positive autoantibodies,168 cases(57.9%)were caused by traditional Chinese medicine and 122 cases(42.1%)were caused by western medicine.The traditional Chinese medicine that caused liver injury were mainly used for the treatment of skin diseases(22.6%)and osteoarthropathy(18.5%).;the western medicine that caused liver damage is mainly composed of antituberculosis drugs(18.9%)and antibiotics(15.6%).Compared with WM group,the cases caused by TM showed more female(81.5%vs 72.1%,x2=7.357,P=0.007),and higher level of AST(237.1 IU/L vs 367.5 IU/L,Z=-2.215,P=0.027),higher level of TBA(77.1 umol/L vs 136.6 umol/L,Z=-2.853,P=0.004),lower level of eosinophils(0.07×109/Lvs0.1×109/L,Z=-3.306,P=0.001).TCM group has lower rash rate than WM group(0 vs 5.74%,,?2=9.878,P=0.002).However,no difference in the distribution of autoantibodies,the types of antinuclear antibodies and liver pathological features(P>0.05).There was no significant difference in the severity of liver injury(Z=-0.320,P=0.749)and prognosis(Z=-0.009,P=0.993)between the TCM group and the WM group.2 Among 168 patients followed up for six months,39 cases(23.2%)whose autoa ntibodies were negative,while 129 cases(76.8%)whose autoantibodies still be positive.The baseline characteristics of the two groups were generally comparable.In the antoan tibodies,the anti-Sm antibody,anti-RNP antibody,anti-histone antibody,and antinuclear a ntibody(ANA)were found to have a higher negative rate within six months than othe r autoantibodies,anti-centromere B protein antibody,anti-mitochondrial antibodies-2(AMA 2),anti-PM-Scl,anti-ribosomal P protein antibody,anti-nucleosome antibody,AMA,PCA,LK M,ACA were not easy to turn negative after six months.The independent factors affect ingthe patient's autoantibody turning negative within six months were gender(HR=0.370,95%CI:0.184-0.744,P=0.005),GLB(HR=0.886,95%CI:0.830-0.945,P<0.001),ANA positi ve(HR=0.323,95%CI:0.130-0.804,P=0.015),and they were risk factors.Conclusions1 The patients in TCM group and WM group were mainly female.Compared with the WM group,the TCM group had higher level of AST and TBA,lower level of eosinophils and rash rate.There were no differences in the distribution of autoantibodies,types of antinuclear antibodies,liver pathological features(P>0.05).There was no significant difference in the severity of liver injury(Z=-0.320,P=0.749)and prognosis(Z=-0.009,P=0.993)between the TCM group and the WM group.2 Female,GLB,ANA positive are independent risk factors of autoantibody turned negative within six months in DILI patients with positive-autoantibody.