药物诱导的自身免疫样肝炎的临床诊断

刘永萍; 沈瑶杰

doi:10.12449/JCH250322

药物诱导的自身免疫样肝炎的临床诊断

DOI: 10.12449/JCH250322

刘永萍¹,
沈瑶杰^2, , ,

1.
浙江中医药大学附属杭州西溪医院肝病科，杭州 310023
2.
浙江省中西医结合医院临床实验中心，杭州 310003

基金项目:

浙江省医药卫生科技计划项目 (2024KY212);

杭州市生物医药和健康产业发展扶持科技专项 (2022WJC283)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：刘永萍负责选题，检索文献，资料分析，撰写论文；沈瑶杰负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
沈瑶杰， shenyaojie2024@163.com （ORCID： 0000-0003-3081-9597）

计量
- 文章访问数: 167
- HTML全文浏览量: 81
- PDF下载量: 33
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-31
- 录用日期: 2024-07-26
- 出版日期: 2025-03-25

Clinical diagnosis of drug-induced autoimmune-like hepatitis

Yongping LIU¹,
Yaojie SHEN^{2
, ,
,}

1.
Department of Hepatology，Hangzhou Xixi Hospital Affiliated to Zhejiang University of Chinese Medicine，Hangzhou 310023，China
2.
Clinical Experiment Center，Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine，Hangzhou 310003，China

Research funding:

Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2024KY212);

Hangzhou Biomedicine and Health Industry Development Support Science and Technology Special Project (2022WJC283)

More Information

Corresponding author: SHEN Yaojie， shenyaojie2024@163.com （ORCID： 0000-0003-3081-9597）

摘要

摘要: 药物性肝损伤（DILI）中部分病例可以表现出与自身免疫性肝炎（AIH）相似的特征，即药物诱导的自身免疫样肝炎（DI-ALH）。2022年欧洲肝病学会对DI-ALH的命名、诊断和临床处理进行了讨论并提出了专家意见，建立了临床诊断标准。然而，DI-ALH的临床诊断依然复杂、困难，药物摄入和机体免疫进展之间的联系目前尚无直接证据。因此，本文从临床表型、病理诊断、诊断积分和临床预后4个方面探讨DI-ALH诊断相关的研究进展。
- 药物诱导的自身免疫样肝炎 /
- 药物性肝损伤 /
- 肝炎，自身免疫性 /
- 诊断
Abstract: Some patients with drug-induced liver injury （DILI） may present with similar features to patients with autoimmune hepatitis （AIH）， and such cases are defined as drug-induced autoimmune-like hepatitis （DI-ALH）. In 2022， the European Association for the Study of the Liver discussed the nomenclature， diagnosis， and treatment of DI-ALH and put forward expert opinions to establish the criteria for clinical diagnosis. However， the clinical diagnosis of DI-ALH remains complex and difficult， and there is no direct evidence for the link between drug intake and the body’s immune progression. Therefore， this article reviews the research advances in the diagnosis of DI-ALH from the four aspects of clinical phenotype， pathological diagnosis， diagnostic score， and clinical prognosis.
- Drug-induced Autoimmune-like Hepatitis /
- Drug-induced Liver Injury /
- Hepatitis， Autoimmune /
- Diagnosis

HTML全文

参考文献(43)

[1]	ROBIN MA, LE ROY M, DESCATOIRE V, et al. Plasma membrane cytochromes P450 as neoantigens and autoimmune targets in drug-induced hepatitis[J]. J Hepatol, 1997, 26( Suppl 1): 23- 30. DOI: 10.1016/s0168-8278(97)82329-x.
[2]	European Association for the Study of the Liver; Clinical Practice Guideline Panel: Chair, members Panel; EASL Governing Board representative. EASL clinical practice guidelines: Drug-induced liver injury[J]. J Hepatol, 2019, 70( 6): 1222- 1261. DOI: 10.1016/j.jhep.2019.02.014.
[3]	TAN CK, HO D, WANG LM, et al. Drug-induced autoimmune hepatitis: A minireview[J]. World J Gastroenterol, 2022, 28( 24): 2654- 2666. DOI: 10.3748/wjg.v28.i24.2654.
[4]	BJÖRNSSON ES, MEDINA-CALIZ I, ANDRADE RJ, et al. Setting up criteria for drug-induced autoimmune-like hepatitis through a systematic analysis of published reports[J]. Hepatol Commun, 2022, 6( 8): 1895- 1909. DOI: 10.1002/hep4.1959.
[5]	BJÖRNSSON E, TALWALKAR J, TREEPRASERTSUK S, et al. Drug-induced autoimmune hepatitis: Clinical characteristics and prognosis[J]. Hepatology, 2010, 51( 6): 2040- 2048. DOI: 10.1002/hep.23588.
[6]	LAMMERT C, ZHU CS, LIAN Y, et al. Exploratory study of autoantibody profiling in drug-induced liver injury with an autoimmune phenotype[J]. Hepatol Commun, 2020, 4( 11): 1651- 1663. DOI: 10.1002/hep4.1582.
[7]	LUCENA MI, KAPLOWITZ N, HALLAL H, et al. Recurrent drug-induced liver injury(DILI) with different drugs in the Spanish Registry: The dilemma of the relationship to autoimmune hepatitis[J]. J Hepatol, 2011, 55( 4): 820- 827. DOI: 10.1016/j.jhep.2010.12.041.
[8]	SUGIMOTO K, ITO T, YAMAMOTO N, et al. Seven cases of autoimmune hepatitis that developed after drug-induced liver injury[J]. Hepatology, 2011, 54( 5): 1892- 1893. DOI: 10.1002/hep.24513.
[9]	STEPHENS C, ROBLES-DIAZ M, MEDINA-CALIZ I, et al. Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry[J]. J Hepatol, 2021, 75( 1): 86- 97. DOI: 10.1016/j.jhep.2021.01.029.
[10]	de BOER YS, KOSINSKI AS, URBAN TJ, et al. Features of autoimmune hepatitis in patients with drug-induced liver injury[J]. Clin Gastroenterol Hepatol, 2017, 15( 1): 103- 112. e 2. DOI: 10.1016/j.cgh.2016.05.043.
[11]	DELEMOS AS, FOUREAU DM, JACOBS C, et al. Drug-induced liver injury with autoimmune features[J]. Semin Liver Dis, 2014, 34( 2): 194- 204. DOI: 10.1055/s-0034-1375959.
[12]	BJÖRNSSON ES, STEPHENS C, ATALLAH E, et al. A new framework for advancing in drug-induced liver injury research. The Prospective European DILI Registry[J]. Liver Int, 2023, 43( 1): 115- 126. DOI: 10.1111/liv.15378.
[13]	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. DOI: 10.1016/j.dld.2014.08.040.
[14]	HENNES EM, ZENIYA M, CZAJA AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis[J]. Hepatology, 2008, 48( 1): 169- 176. DOI: 10.1002/hep.22322.
[15]	SUZUKI A, BRUNT EM, KLEINER DE, et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury[J]. Hepatology, 2011, 54( 3): 931- 939. DOI: 10.1002/hep.24481.
[16]	LIWINSKI T, HEINEMANN M, SCHRAMM C. The intestinal and biliary microbiome in autoimmune liver disease-current evidence and concepts[J]. Semin Immunopathol, 2022, 44( 4): 485- 507. DOI: 10.1007/s00281-022-00936-6.
[17]	STRICKER BH, BLOK AP, CLAAS FH, et al. Hepatic injury associated with the use of nitrofurans: A clinicopathological study of 52 reported cases[J]. Hepatology, 1988, 8( 3): 599- 606. DOI: 10.1002/hep.1840080327.
[18]	EFE C, KULKARNI AV, BERETTA-PICCOLI BT, et al. Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome[J]. Hepatology, 2022, 76( 6): 1576- 1586. DOI: 10.1002/hep.32572.
[19]	CODONI G, KIRCHNER T, ENGEL B, et al. Histological and serological features of acute liver injury after SARS-CoV-2 vaccination[J]. JHEP Rep, 2022, 5( 1): 100605. DOI: 10.1016/j.jhepr.2022.100605.
[20]	ZHU JQ, CHEN MJ, BORLAK J, et al. The landscape of hepatobiliary adverse reactions across 53 herbal and dietary supplements reveals immune-mediated injury as a common cause of hepatitis[J]. Arch Toxicol, 2020, 94( 1): 273- 293. DOI: 10.1007/s00204-019-02621-4.
[21]	WEBER S, BENESIC A, BUCHHOLTZ ML, et al. Antimitochondrial rather than antinuclear antibodies correlate with severe drug-induced liver injury[J]. Dig Dis, 2021, 39( 3): 275- 282. DOI: 10.1159/000511635.
[22]	BERNAL W, MA Y, SMITH HM, et al. The significance of autoantibodies and immunoglobulins in acute liver failure: A cohort study[J]. J Hepatol, 2007, 47( 5): 664- 670. DOI: 10.1016/j.jhep.2007.05.011.
[23]	VUPPALANCHI R, GOULD RJ, WILSON LA, et al. Clinical significance of serum autoantibodies in patients with NAFLD: Results from the nonalcoholic steatohepatitis clinical research network[J]. Hepatol Int, 2012, 6( 1): 379- 385. DOI: 10.1007/s12072-011-9277-8.
[24]	COVELLI C, SACCHI D, SARCOGNATO S, et al. Pathology of autoimmune hepatitis[J]. Pathologica, 2021, 113( 3): 185- 193. DOI: 10.32074/1591-951X-241.
[25]	TAN EM, FELTKAMP TE, SMOLEN JS, et al. Range of antinuclear antibodies in“healthy” individuals[J]. Arthritis Rheum, 1997, 40( 9): 1601- 1611. DOI: 10.1002/art.1780400909.
[26]	HISAMOCHI A, KAGE M, IDE T, et al. An analysis of drug-induced liver injury, which showed histological findings similar to autoimmune hepatitis[J]. J Gastroenterol, 2016, 51( 6): 597- 607. DOI: 10.1007/s00535-015-1131-7.
[27]	STEPHENS C, CASTIELLA A, GOMEZ-MORENO EM, et al. Autoantibody presentation in drug-induced liver injury and idiopathic autoimmune hepatitis: The influence of human leucocyte antigen alleles[J]. Pharmacogenet Genomics, 2016, 26( 9): 414- 422. DOI: 10.1097/FPC.0000000000000230.
[28]	AHMAD J, BARNHART HX, BONACINI M, et al. Value of liver biopsy in the diagnosis of drug-induced liver injury[J]. J Hepatol, 2022, 76( 5): 1070- 1078. DOI: 10.1016/j.jhep.2021.12.043.
[29]	TSUTSUI A, HARADA K, TSUNEYAMA K, et al. Clinicopathological study of autoimmune hepatitis cases that were difficult to differentiate from drug-induced liver injury[J]. Dig Dis, 2017, 35( 6): 506- 514. DOI: 10.1159/000480139.
[30]	LOHSE AW, SEBODE M, BHATHAL PS, et al. Consensus recommendations for histological criteria of autoimmune hepatitis from the International AIH Pathology Group: Results of a workshop on AIH histology hosted by the European Reference Network on Hepatological Diseases and the European Society of Pathology[J]. Liver Int, 2022, 42( 5): 1058- 1069. DOI: 10.1111/liv.15217.
[31]	FEBRES-ALDANA CA, ALGHAMDI S, KRISHNAMURTHY K, et al. Liver fibrosis helps to distinguish autoimmune hepatitis from DILI with autoimmune features: A review of twenty cases[J]. J Clin Transl Hepatol, 2019, 7( 1): 21- 26. DOI: 10.14218/JCTH.2018.00053.
[32]	CHALASANI N, LI YJ, DELLINGER A, et al. Clinical features, outcomes, and HLA risk factors associated with nitrofurantoin-induced liver injury[J]. J Hepatol, 2023, 78( 2): 293- 300. DOI: 10.1016/j.jhep.2022.09.010.
[33]	CASTIELLA A, ZAPATA E, ISABEL LUCENA M, et al. Drug-induced autoimmune liver disease: A diagnostic dilemma of an increasingly reported disease[J]. World J Hepatol, 2014, 6( 4): 160- 168. DOI: 10.4254/wjh.v6.i4.160.
[34]	ROCKEY DC, SEEFF LB, ROCHON J, et al. Causality assessment in drug-induced liver injury using a structured expert opinion process: Comparison to the Roussel-Uclaf causality assessment method[J]. Hepatology, 2010, 51( 6): 2117- 2126. DOI: 10.1002/hep.23577.
[35]	AGARWAL VK, MCHUTCHISON JG, HOOFNAGLE JH, et al. Important elements for the diagnosis of drug-induced liver injury[J]. Clin Gastroenterol Hepatol, 2010, 8( 5): 463- 470. DOI: 10.1016/j.cgh.2010.02.008.
[36]	CHALASANI N, BJÖRNSSON E. Risk factors for idiosyncratic drug-induced liver injury[J]. Gastroenterology, 2010, 138( 7): 2246- 2259. DOI: 10.1053/j.gastro.2010.04.001.
[37]	European Association for the Study of the Liver. EASL clinical practice guidelines: Autoimmune hepatitis[J]. J Hepatol, 2015, 63( 4): 971- 1004. DOI: 10.1016/j.jhep.2015.06.030.
[38]	ALVAREZ F, BERG PA, BIANCHI FB, et al. International autoimmune hepatitis group report: Review of criteria for diagnosis of autoimmune hepatitis[J]. J Hepatol, 1999, 31( 5): 929- 938. DOI: 10.1016/s0168-8278(99)80297-9.
[39]	UZUN S, ZINNER CP, BEENEN AC, et al. Morphologic and molecular analysis of liver injury after SARS-CoV-2 vaccination reveals distinct characteristics[J]. J Hepatol, 2023, 79( 3): 666- 676. DOI: 10.1016/j.jhep.2023.05.020.
[40]	CZAJA AJ. Drug-induced autoimmune-like hepatitis[J]. Dig Dis Sci, 2011, 56( 4): 958- 976. DOI: 10.1007/s10620-011-1611-4.
[41]	BACHMEYER C, CADRANEL JF. Minocycline-induced lupus and autoimmune hepatitis: Family autoimmune disorders as possible risk factors[J]. Dermatology, 2002, 205( 2): 185- 186. DOI: 10.1159/000063890.
[42]	GARCÍA-CORTÉS M, ORTEGA-ALONSO A, MATILLA-CABELLO G, et al. Clinical presentation, causative drugs and outcome of patients with autoimmune features in two prospective DILI registries[J]. Liver Int, 2023, 43( 8): 1749- 1760. DOI: 10.1111/liv.15623.
[43]	WEBER S, GERBES AL. Relapse and need for extended immunosuppression: Novel features of drug-induced autoimmune hepatitis[J]. Digestion, 2023, 104( 3): 243- 248. DOI: 10.1159/000528329.