Clinical Characteristic Of Drug-Induced Liver Injury And Its Differential Diagnosis From Autoimmune Liver Disease

Background and Objective: Drug-induced liver injury（DILI）is acute or chronic liver injury caused by drugs,metabolites or specific liver toxicity.DILI is gradually becoming an important cause of liver failure.And its clinical manifestations can range from asymptomatic liver dysfunction to asymptomatic acute or chronic liver injury.DILI is an exclusive diagnosis.Viral hepatitis patients can be identified by detecting the markers of hepatitis virus.Patients with alcoholic liver disease may have a long-term history of drinking,which can be identified by asking about the history of drinking.And PSC is rarely can be seen in daily work.ALD and DILI can be injured by immune-mediated,and the identification is relatively difficult.Therefore,the aim of this study is to analysis the clinical characteristics of DILI,AIH and PBC to provide basis for differential diagnosis.Materials and Methods:A total of Fifty-six patients with DILI,forty-five patients with AIH and thirty-three patients with PBC treated in the First affiliated Hospital of Anhui Medical University from January 2013 to December 2020 were selected.All patients underwent liver biopsy.Demographic data,clinical features and pathological biopsy were compared in patients with DILI,AIH and PBC.ANOVA analysis or Kruskal-Wallis H test was used for the comparison of quantitative variables between group.Bonferroni method was used to correct the P value.Comparison of categorical data between groups was performed using the chi-square test,fisher’s exact or Kruskal-Wallis H test as appropriate.Results:The mean age of onset was（46.3±13.4）yr for DILI patients,（51.3±12.7）yr for AIH patients,and（52.5±8.5）yr for PBC patients.Female patients accounted for77.8% and 90.9% respectively in AIH and PBC group,which were significantly higher than that in DILI group（53.6%,P<0.05）.Poor appetite and Jaundice often appeared in patients with DILI or AIH（P<0.05）.ALT,AST,and TBIL in DILI group were significantly higher than that in AIH group and PBC group（P<0.05）.TBIL,GLB,PT,APTT,Ig G and Ig A rose remarkably in AIH group,which were higher than that in DILI group and PBC group（P<0.05）.ALB in AIH group was lower than that in DILI group and PBC group.The high antibody titer（≧1:3200）was helpful in diagnosis of AIH and the antibody positive of AMA and gp210 could help the diagnosis of PBC.ALP,GGT and Ig M were elevated more significantly in PBC group than that in DILI group and PBC group.In terms of liver biopsy,cholestasis and eosinophil infiltration in portal area were features that favored DILI,The pathological features of patients with AIH were mainly interface hepatitis,focal necrosis,eosinophil infiltration in portal area,intra-acinar plasma cells,rosette formation and emperiopolesis.Small bile ducts injury or decreased number and liver tissue fibrosis were features that favored PBC.Conclusions:1.The patients in three groups are mainly middle-aged people.Female patients are more common in AIH group and PBC group.There is no significant difference in the proportion of men and women in DILI group.Poor appetite and Jaundice often appeared in patients with DILI or AIH.The clinical manifestation of PBC patients are diverse.2.When ALT,AST and TBIL are increased,it is significant for the diagnosis of DILI.When ALP,GGT and Ig M rise remarkably and AMA or gp210 is positive,it is significant for the diagnosis of PBC.The decrease of ALB,the increase of GLB and Ig G,positive AMA or SMA and high antibody titer are of significance in the diagnosis of AIH.3.In terms of liver histology,Cholestasis and eosinophil infiltration in portal area are features that favored DILI.Interface hepatitis,focal necrosis,eosinophil infiltration in portal area,intra-acinar plasma cells,rosette formation and emperiopolesis are meaningful for the diagnosis of AIH..Small bile ducts injury or decreased number and liver tissue fibrosis are meaningful for the diagnosis of PBC.