自身抗体阳性药物性肝损伤患者临床转归影响因素分析

目的:观察伴自身抗体阳性药物性肝损伤患者自发病起至半年内自身抗体是否阴转,分析影响自身抗体转阴的因素。方法:采用回顾性研究方法,收集首都医科大学附属北京地坛医院主要诊断为药物性肝损伤且血清学自身抗体检测至少有一项阳性的患者资料。根据半年内患者自身抗体是否阴转,分为转阴组和未转阴组。比较两组患者的性别、年龄、服药史、肝损伤类型、肝功能指标及自身抗体分布等临床数据。结果:转阴组患者肝细胞损伤型32例(32/43,74.4%),未转阴组患者肝细胞损伤型89例(89/143,62.2%),两组比较差异无统计学意义(P>0.05);入组时转阴组重度黄疸患者较未转阴组占比多(21/43,48.8%vs 29/143,20.3%)、半年内转阴组患者肝功能恢复率较未转阴组高(28/43,65.1%vs 47/143,32.9%)、球蛋白水平相对较低[28.1(26.7~31.8)vs 32.3(28.5~37.1)],但均处于正常范围内,两组比较差异有统计学意义(均P<0.05);与未转阴组比较,转阴组患者只存在一种自身抗体阳性的病例数占比较高,差异有统计学意义(P<0.05)。结论:伴自身抗体阳性药物性肝损伤患者在半年内有接近1/4的患者自身抗体阴转,且以仅存在一种自身抗体阳性的病例为主;半年内患者自身抗体阴转病例肝功能恢复相对较好,仅存在一种自身抗体阳性患者自身抗体转阴相对容易,且自身抗体转阴可能更有利于肝功能的恢复。

Analysis of influencing factors of clinical outcome in 186 patients with the drug-induced liver injury with positive autoantibodies

Objective:By observing whether the patients with the drug-induced liver injury with positive autoantibody had the negative transformation of the autoantibody within half a year from the onset of the disease,the factors influencing the negative transformation of the autoantibody were compared and analyzed.Methods:A retrospective study was conducted to collect patients who were mainly diagnosed with drug-induced liver injury and had at least one positive serological autoantibody test in Beijing ditan hospital affiliated to capital medical university from August 2008 to January 2018.According to whether the autoantibodies turned negative within half a year,they were divided into negative turning(NT)group and non-negative turning(NNT)group.The clinical data of gender,age,medication history,liver injury type,liver function index,and distribution of autoantibodies were compared between the two groups.Results:Firstly,in the 186 patients,43(43/186,23%)were in the NT group and 143(143/186,77%)were in the NNT group.There were 32 cases(32/43,74.4%)of liver cell injury in the NT group and 89 cases(89/143,62.2%)of liver cell injury in the NNT group,and the difference between the two groups was not statistically significant(P>0.05);Secondly,in patients with severe jaundice,the proportion of patients in the NT group was higher than that in the NNT group(21/43,48.8%VS,20.3%),the recovery rate of liver function in the NT group within half a year was higher than that in the NNT group(28/43,65.1%VS 47/143,32.9%),and the level of globulin was relatively low(28.1[26.7-31.8]VS 32.3[28.5-37.1]).But they were in the normal range,and the difference between the two groups was statistically significant(P<0.05);Thirdly,the proportion of cases positive for only one autoantibody was higher in patients of the NT group compared to the NNT group(P<0.05).Conclusion:Nearly a quarter of the patients with the drug-induced liver injury with positive autoantibody had the negative transformation of autoantibody within half a year,and the majority of the patients had only one positive autoantibody;Besides,in half a year,the liver function of patients with the negative transformation of autoantibodies recovered relatively well,and it was relatively easy for patients with positive autoantibodies to turn into negative autoantibodies,and autoantibody turning into negative may be more conducive to the recovery of liver function.