Clinicopathological features of drug-induced liver injury or primary biliary cholangitis with vanishing bile duct syndrome

Objective To investigate the clinical features of patients with drug-induced liver injury ( DILI) and vanishing bile duct syndrome ( VBDS) and patients with primary biliary cholangitis ( PBC) and VBDS. Methods A retrospective analysis was performed for the clinical data of 42 DILI patients and 43 PBC patients who visited Shijiazhuang Fifth Hospital from January 2003 to January 2018 were diagnosed with VBDS by liver biopsy, including general information, clinical symptoms and signs, and serological markers, and pathomorphological features were observed. The Mann-Whitney U rank sum test was used for comparison between two groups; the chi-square test was used for comparison of categorical data between groups. Results Most of the patients in the two groups were female patients aged 40-50 years. The D-VBDS group had a significantly higher incidence rate of yellow staining of skin and sclera than the P-VBDS group ( X2=5. 683, P = 0. 017) . Comparison of the peak values of liver biochemical indices showed that compared with the P-VBDS group, the D-VBDS group had significantly higher total bilirubin ( Z =-2. 020, P = 0. 043) and direct bilirubin ( Z =-2. 910, P = 0. 004) . According to the results of pathomorphological analysis and morphological scores of the portal area, the P-VBDS group had significantly higher morphological scores of portal inflammation, fibrosis, and granuloma than the D-VBDS group ( Z =-3. 136, -2. 710, and-2. 913, P =0. 002, 0. 007, and 0. 005) . The morphological scores of the hepatic lobules showed that compared with the P-VBDS group, the D-VBDS group had significantly higher morphological scores of intralobular inflammation, bile thrombus in bile capillary, and activated phagocytes ( Z =-3. 255, -2. 455, and-4. 398, P = 0. 001, 0. 014, and < 0. 001) . Conclusion Pathomorphological features of the liver are objective and accurate indices for the differentiation between DILI with VBDS and PBS with VBDS and have great significance in making a definite diagnosis, understanding the degree of injury, and predicting prognosis.