药物性肝损伤患者自身抗体的检出率及其临床意义

姜红丽; 祁亚宾; 张睿; 胡玉琳

doi:10.3969/j.issn.1001-5256.2018.01.034

药物性肝损伤患者自身抗体的检出率及其临床意义

DOI: 10.3969/j.issn.1001-5256.2018.01.034

1. 吉林省肝胆病医院内科六疗区
2. 河南省人民医院
3. 吉林大学第一医院

详细信息

中图分类号: R575
计量
- 文章访问数: 1526
- HTML全文浏览量: 24
- PDF下载量: 385
- 被引次数: 0
出版历程
- 出版日期: 2018-01-20

Detection rates of autoantibodies in patients with drug-induced liver injury and their clinical significance

Sixth Therapeutic Area, Department of Internal Medicine, Hepatology Hospital of Jilin Province, Changchun 130062, China

摘要

摘要:
目的探讨药物性肝损伤患者自身抗体的检出率及其临床意义。方法选取2009年1月-2013年12月吉林大学第一医院收治的药物性肝损伤患者132例,同时收集同期住院治疗的慢性乙型肝炎患者96例为对照。统计并分析患者自身抗体的检出率、自身抗体的种类及滴度,以及患者年龄、性别、肝损伤药物种类、发病时间、肝功能生化、凝血常规指标等。计数资料组间比较采用χ2检验。结果药物性肝损伤患者自身抗体的检出率为60.6%（80/132）,主要为抗核抗体、抗平滑肌抗体、抗线粒体抗体,检出率分别为56.1%、12.9%、3.0%,抗体滴度以低滴度、中滴度为主。慢性乙型肝炎组自身抗体的检出率为45.8%（44/96）,低于药物性肝损伤组,差异有统计学意义（χ2=4.889,P=0.027）。药物性肝损伤患者自身抗体的检出率与性别、年龄、分型、Child-Pugh分级均无关;与用药时间相关,用药时间>1个月与≤1个月患者自身抗体阳性率比较差异有统计学意义（68.9%vs 40.6%,χ2=7.963,P=0.004 8）。结论药物性肝损伤患者可检...
- 药物性肝损伤 /
- 自身抗体
Abstract:
Objective To investigate the detection rates of autoantibodies in patients with drug-induced liver injury ( DILI) and their clinical significance. Methods A total of 132 patients with DILI who were admitted to The First Hospital of Jilin University from January 2009 to December 2013 were enrolled, and 96 patients with chronic hepatitis B ( CHB) who were hospitalized during the same period of time were enrolled as controls. The patients were analyzed with respect to the detection rate of autoantibody, titers and types of autoantibodies, age, sex, type of drugs inducing liver injury, time of onset, biochemical parameters for liver function, and coagulation parameters. The chi-square test was used for comparison of categorical data between groups. Results In the patients with DILI, the detection rate of autoantibodies was 60. 6% ( 80/132) , and the detection rates of anti-nuclear antibody, anti-smooth muscle antibody, and anti-mitochondrial antibody were 56. 1% , 12. 9% , and 3. 0% , retrospectively; the antibody titer was mainly low titer and moderate titer. In patients with CHB, the detection rate of autoantibodies was 45. 8% ( 44/96) , which was significantly lower than the detection rate in the patients with DILI ( χ2= 4. 889, P = 0. 027) . In the patients with DILI, the detection rate of autoantibodies was not associated with sex, age, typing, or Child-Pugh class, while it was associated with medication time, and there was a significant difference in the positive rate of autoantibody between the patients with a medication time of > 1 month and those with a medication time of ≤1 month ( 68. 9% vs 40. 6% , χ2= 7. 963, P = 0. 004 8) . Conclusion A variety of autoantibodies can be detected in patients with DILI, mainly low-and moderate-titer autoantibodies, among which anti-nuclear antibody is the most common one. The detection rate of autoantibody increases with the increase in medication time.
- drug-induced liver injury /
- autoantibodies

HTML全文

参考文献(13)

[1]LU RJ, ZHANG Y, TANG FL, et al.Clinical characteristics of drug-induced liver injury and related risk factors[J].Exp Ther Med, 2016, 12 (4) :2606-2616.

[2]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.

[3]HU Q, LIU W, SHAO H.Research progress of pharmacotherapy drug-induced liver injury[J].Chin J Clin Pharmacol Ther, 2016, 21 (2) :231-236. (in Chinese) 胡琴, 刘维, 邵宏.药物性肝损伤的药物治疗研究进展[J].中国临床药理学与治疗学, 2016, 21 (2) :231-236.

[4]Mc GILL MR, JAESCHKE H.MicroRNAs as signaling mediators and biomarkers of drug-and chemical-induced liver injury[J].J Clin Med, 2015, 4 (5) :1063-1078.

[5]WARD J, KANCHAGAR C, VEKSLER-LUBLINSKY I, et al.Circulating microRNA profiles in human patients with acetaminophen hepatotoxicity or ischemic hepatitis[J].Proc Natl Acad Sci U S A, 2014, 111 (33) :12169-12174.

[6] MIAO XH.Mechanism of drug-induced liver injury[M]//CHEN CW.Drug-induced and toxic liver disease.Shanghai:Shanghai Scientific&Technical Publishers, 2002:130-242. (in Chinese) 缪晓辉.药物性肝损害机制[M]//陈成伟.中毒与药物性肝病.上海:上海科技出版社, 2002:130-242.

[7]DESCOTES J.Importance of immunotoxicity in safety assessment:a medical toxicologist's perspective[J].Toxicol Lett, 2004, 149 (1-3) :103-108.

[8]LIAN M, HUA J, SHENG L, et al.Prevalence and significance of autoantibodies in patients with alcoholic liver disease[J].J Dig Dis, 2013, 14 (7) :396-401.

[9]HUANG CY, LIU YM, HUANG YL, et al.Drug-induced liver injury accompanied by autoimmune phenomena:an analysis of clinical characteristics[J].J Clin Hepatol, 2015, 31 (8) :1303-1306. (in Chinese) 黄春洋, 刘燕敏, 黄云丽, 等.药物性肝损伤患者伴自身免疫现象的临床特点分析[J].临床肝胆病杂志, 2015, 31 (8) :1303-1306.

[10]YANG J, YU YL, JIN Y, et al.Clinical characteristics of drug-induced liver injury and primary biliary cirrhosis[J].World J Gastroenterol, 2016, 22 (33) :7579-7586.

[11]LICATA A, MAIDA M, CABIBI D, et al.Clinical features and outcomes of patients with drug-induced autoimmune hepatitis:a retrospective cohort study[J].Dig Liver Dis, 2014, 46 (12) :1116-1120.

[12]JU HY, JANG JY, JEONG SW, et al.The clinical features of drug-induced liver injury observed through liver biopsy:focus on relevancy to autoimmune hepatitis[J].Clin Mol Hepatol, 2012, 18 (2) :213-218.

[13]OH HJ, MOK YM, BAEK MS, et al.Co-development of autoimmune hepatitis and Sj9gren's syndrome triggered by the administration of herbal medicines[J].Clin Mol Hepatol, 2013, 19 (3) :305-308.

施引文献

资源附件(0)

访问统计