The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis

초록

Background/Aims: Accurate diagnosis of drug-induced liver injury (DILI) is difficult without considering the possibility of underlying diseases, especially autoimmune hepatitis (AIH). We investigated the clinical patterns in patients with a history of medication, liver-function abnormalities, and in whom liver biopsy was conducted, focusing on accompaniment by AIH. Methods: The clinical, serologic, and histologic findings of 29 patients were compared and analyzed. The patients were aged 46.2 +/- 12.8 years (mean +/- SD), and 72.4% of patient were female. The most common symptom and causal drug were jaundice (58.6%) and herbal medications (55.2%), respectively. Results: Aspartate aminotransferase (AST), alanine aminotransferase, total bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase levels were 662.2 +/- 574.8 U/L, 905.4 +/- 794.9 U/L, 12.9 +/- 10.8 mg/dL, 195.8 +/- 123.3 U/L, and 255.3 +/- 280.8 U/L, respectively. According to serologic and histologic findings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited significantly higher AST levels (537.1 +/- 519.1 vs. 1043.3 +/- 600.5 U/L), globulin levels (2.7 +/- 0.4 vs. 3.3 +/- 0.5 g/dL), and prothrombin time (12.9 +/- 2.4 vs. 15.2 +/- 3.9 s; P<0.05). Antinuclear antibody was positive in 7 of 21 cases of DILI and all 8 cases of AIH (P=0.002). The simplified AIH score was 3.7 +/- 0.9 in the DILI group and 6.5 +/- 0.9 in the AIH group (P<0.001). Conclusions: Accurate diagnosis is necessary for patients with a history of medication and visits for liver-function abnormalities; in particular, the possibility of AIH should be considered.

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