More and more cases of drug-induced liver injury have been reported. Drug-induced autoimmune hepatitis (DI-AIH) may occur because some drugs or its metabolites may bind to a hepatocyte surface protein, forming a neoantigen and activating autoimmune reaction, and/or due to such factors as genetic susceptibility, female and advanced age, etc. The symptoms of DIAIH are often concealed, but a few DIAIH patients can develop liver failure rapidly. Significant increase in biliary enzyme levels and disorder of bilirubin metabolism are general manifestations, while AST and ALT may elevate moderately. Unlike AIH, the autoantibodies in DIAIH patinets can change to be negative with disease improvement. In radiological findings, DIAIH usually presents with lobe liver atrophy, delayed-phase images, and few can develop cirrhosis. Diagnosis depends on the roussel uclaf causality assessment method (RUCAM) and clinical diagnostic scale (modified RUCAM). Good response to corticosteroids (CS) treatment is also an important prognostic factor. Complete remission in 1 -3 months and no relapse after withdrawal of CS mean fine prognosis. DIAIH is an a-cute auto-limit disease, and has a good outcome if diagnosis and treatment are given correctly and promptly.%随着药物(或中草药、保健品)的滥用和“被用”,药物性肝损害不断增加.某些药物本身或代谢产物可与蛋白结合形成半抗原,刺激机体发生免疫反应,和(或)由于宿主的遗传易感性、女性、高龄等因素,导致药物诱发自身免疫性肝炎( drug-induced autoimmune hepatitis,DIAIH)的发生.DIAIH的临床症状多数隐匿,但也可迅速发展致肝衰竭.一般表现为胆道酶增加和胆红素排泄障碍,AST和ALT通常为中等度升高.自身抗体的出现与AIH相似,但随着疾病的好转迅速转阴.影像学上DIAIH可见明显的肝叶萎缩、门脉期强化和造影剂排泄延迟,多数不发展至肝硬化.诊断包括因果关系评估方法(roussel uclaf causality assessment method,RUCAM)评分及改良后的RUCAM.对糖皮质激素的良好反应是诊断的另一个线索,停用糖皮质激素后病情不复发,1～3个月可以完全缓解.DIAIH是一种急性自限性肝炎,如果及时诊断、正确处理,预后良好.
展开▼
