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KMID : 1103920120180020213
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Korean Journal of Hepatology
2012 Volume.18 No. 2 p.213 ~ p.218
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The clinical features of drug-induced liver injury observed through liver biopsy: focus on relevancy to autoimmune hepatitis
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Ju Hye-Young
Jang Jae-Young
Jeong Soung-Won
Woo Sung-Ae
Kong Min-Gyu
Jang Hee-Yoon
Lee Sae-Hwan
Kim Sang-Gyune
Cha Sang-Woo
Kim Young-Seok
Cho Young-Deok
Jin So-Young
Kim Hong-Soo
Kim Boo-Sung
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Abstract
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Background/Aims: Accurate diagnosis of drug-induced liver injury (DILI) is diffi cult 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 fi ndings 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 γ-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 fi ndings, 21 cases were diagnosed with DILI and 8 with AIH. The AIH group exhibited signifi cantly 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 simplifi ed 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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KEYWORD
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Drug-induced liver injury, Autoimmune hepatitis, Diagnosis
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