title: [Clinical features of drug-induced autoimmune hepatitis and drug-induced liver injury: a comparative analysis].
abstract: OBJECTIVE
  To investigate the clinical features of drug-induced autoimmune hepatitis (DIAIH) and its therapeutic strategies, and to provide a reference for early diagnosis and treatment of this disease and prevention of chronicity.
  
  
  METHODS
  The clinical data of 116 patients with drug-induced liver injury (DILI) or DIAIH confirmed by medical history, liver biochemistry, and liver biopsy were analyzed retrospectively. Among these patients, 13 had DIAIH and 103 had simple DILI (30 patients in the hepatocyte-type group and 73 in the cholestasis/mixed-type group). The population characteristics, major drugs inducing the diseases, clinical manifestations, liver biochemical parameters, liver pathological features, and clinical outcome were compared between groups. The Kruskal-wallis H test was used for comparison and the Mann-Whitney U test was used for comparison between any two groups. The chi-square test was used for comparison of categorical data, and the R×C chi-square test was used for comparison of rates between the three groups; in the case of significant differences, the R×C contingency table was used for comparison between any two groups.
  
  
  RESULTS
  The patients with DIAIH had a mean age of 53.54±8.28 years, and the mean age was 35.13±13.46 and 46.99±14.82 years for the hepatocyte-type group and cholestasis/mixed-type group, respectively. The disease was mainly induced by a combination of various drugs. The patients with DIAIH had significantly higher serum levels of alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, and alkaline phosphatase and a significantly higher positive rate of anti-nuclear antibody than those with DILI (all P < 0.05). In patients with DIAIH, the liver pathological features and the features of response to treatment were as follows: obvious interface hepatitis, proliferation of small bile ducts, and mixed inflammatory cell infiltration in the portal area, including eosinophils and plasma cells, and the short-term corticosteroid therapy had a good therapeutic effect.
  
  
  CONCLUSIONS
  DIAIH has a low incidence and is more common in the female population, with the features of tissue injury in both DILI and autoimmune hepatitis. The short-term corticosteroid therapy can prevent disease progression and reduce chronicity.
authors.affiliation: Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
authors.forename: S X
authors.initials: SX
authors.lastname: Zhao
authors.forename: Y G
authors.initials: YG
authors.lastname: Zhang
authors.forename: P F
authors.initials: PF
authors.lastname: Tan
authors.forename: R Q
authors.initials: RQ
authors.lastname: Wang
authors.forename: Y M
authors.initials: YM
authors.lastname: Nan
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000473:pathology; D002779:Cholestasis / Q000175:diagnosis; D018450:Disease Progression; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000974:Antibodies, Antinuclear; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase