Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2016; 22(33): 7579-7586
Published online Sep 7, 2016. doi: 10.3748/wjg.v22.i33.7579
Clinical characteristics of drug-induced liver injury and primary biliary cirrhosis
Jun Yang, Ya-Li Yu, Yu Jin, Ying Zhang, Chang-Qing Zheng
Jun Yang, Ya-Li Yu, Yu Jin, Ying Zhang, Chang-Qing Zheng, Division II, Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang 110024, Liaoning Province, China
Author contributions: Zheng CQ designed the research; Yang J, Yu YL, Jin Y and Zhang Y performed the research; Yu YL and Zhang Y provided new agents and analytic tools; and Yang J wrote the paper.
Institutional review board statement: This study is a retrospective study of the clinical data of patients. The content of the study is not related to the ethical issues.
Informed consent statement: The authors of this paper guarantee that all study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There are no conflicts of interest in relation to this manuscript.
Data sharing statement: There are no additional data available in relation to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Chang-Qing Zheng, Professor, Division II, Department of Gastroenterology, Shengjing Hospital, China Medical University, No. 39 Huangxiang Road, Tiexi District, Shenyang 110024, Liaoning Province, China. zhengchangqing88@163.com
Telephone: +86-24-9661526211 Fax: +86-24-9661510351
Received: April 5, 2016
Peer-review started: April 6, 2016
First decision: May 12, 2016
Revised: June 20, 2016
Accepted: July 6, 2016
Article in press: July 6, 2016
Published online: September 7, 2016
Abstract
AIM

To summarize and compare the clinical characteristics of drug-induced liver injury (DILI) and primary biliary cirrhosis (PBC).

METHODS

A total of 124 patients with DILI and 116 patients with PBC treated at Shengjing Hospital Affiliated to China Medical University from 2005 to 2013 were included. Demographic data (sex and age), biochemical indexes (total protein, albumin, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, alkaline phosphatase, and gamma glutamyltransferase), immunological indexes [immunoglobulin (Ig) A, IgG, IgM, antinuclear antibody, anti-smooth muscle antibody, anti-mitochondrial antibody, and anti-mitochondrial antibodies] and pathological findings were compared in PBC patients, untyped DILI patients and patients with different types of DILI (hepatocellular type, cholestatic type and mixed type).

RESULTS

There were significant differences in age and gender distribution between DILI patients and PBC patients. Biochemical indexes (except ALB), immunological indexes, positive rates of autoantibodies (except SMA), and number of cases of patients with different ANA titers (except the group at a titer of 1:10000) significantly differed between DILI patients and PBC patients. Biochemical indexes, immunological indexes, and positive rate of autoantibodies were not quite similar in different types of DILI. PBC was histologically characterized mainly by edematous degeneration of hepatocytes (n = 30), inflammatory cell infiltration around bile ducts (n = 29), and atypical hyperplasia of small bile ducts (n = 28). DILI manifested mainly as fatty degeneration of hepatocytes (n = 15) and spotty necrosis or loss of hepatocytes (n = 14).

CONCLUSION

Although DILI and PBC share some similar laboratory tests (biochemical and immunological indexes) and pathological findings, they also show some distinct characteristics, which are helpful to the differential diagnosis of the two diseases.

Keywords: Drug-induced liver injury, Primary biliary cirrhosis, Autoantibodies, Immunoglobulin, Differential diagnosis, Pathological findings

Core tip: This is a retrospective study to distinguish differential diagnosis of drug-induced liver injury (DILI) and primary biliary cirrhosis (PBC). There are many similarities between the clinical manifestations and biochemical tests of the two diseases. DILI and PBC also show some distinct characteristics, which are helpful to the differential diagnosis of the two diseases.