Development of a differentiation model for autoimmune hepatitis and drug-induced liver injury based on hepatic ultrasound hemodynamics and liver biochemical indicators

Abstract

Abstract: Objective To distinguish between DIAIH and DILI, a differential diagnosis model for drug-induced autoimmune hepatitis (DIAIH) and drug-induced liver injury (DILI) was established based on hepatic ultrasound hemodynamics and liver biochemical indicators. Methods A retrospective analysis was conducted on medical records of 82 cases of drug-induced liver injury (DILI) and 74 cases of drug-induced autoimmune hepatitis (DIAIH) admitted to the hospital from January 2020 to January 2023. The study aimed to analyze the differences in hepatic ultrasound hemodynamics and liver biochemical indicators between the DILI and DIAIH groups, identify factors influencing the onset of DIAIH, and establish a differentiation model for DILI and DIAIH. Results The portal vein blood flow velocity in DILI group was higher than that in DIAIH group, and the hepatic artery blood flow velocity and resistance index were lower than that in DIAIH group [DILI group: (22.31±3.19) cm/s, (40.23±6.47) cm/s, (0.71±0.13) cm/s, DIAIH group: (19.49±3.02) cm/s (46.91±7.15) cm/s, (0.79±0.12) cm/s] (P<0.05). The levels of total bilirubin, total bile acid, alkaline phosphatase (ALP), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) and globulin in DILI group were lower than those in DIAIH group [DILI group (18.62) μmol/L, (7.56) μmol/L, (96.05) U/L, (206). 53) U/L, (112.35) U/L, (29.13) g/L, DIAIH group (26.01) μmol/L, (22.61) μmol/L, (129.52) U/L, (328.65) U/L, (199.34) U/L, (35.02) g/L, ] (P<0.05). Portal vein blood flow velocity, hepatic artery blood flow velocity, resistance index, total bilirubin, total bile acids, and ALT were identified as influencing factors for the occurrence of DIAIH (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that the sensitivity of the column chart model in distinguishing DIAIH was 0.825 (95%CI: 0.741~0.952), the specificity was 0.798 (95%CI: 0.703~0.883), and the area under the curve was 0.827 (95%CI: 0.749~0.964). Conclusion There are differences in hepatic ultrasound hemodynamics and liver biochemical indicators between DILI and DIAIH patients. Constructing a differentiation model based on hepatic ultrasound hemodynamics and liver biochemical indicators could be used to assist in the diagnostic differentiation of DILI and DIAIH.

Key words: Drug-induced liver injury, Drug-induced autoimmune hepatitis, Ultrasound hemodynamics, Biochemical indicators, Differentiation model

LIU Xiao-fang, KE Jian-mei. Development of a differentiation model for autoimmune hepatitis and drug-induced liver injury based on hepatic ultrasound hemodynamics and liver biochemical indicators[J]. Chinese Hepatolgy, 2025, 30(9): 1267-1271.

References

[1] 符馨尹, 林小茹, 郑秀芬, 等. 药物诱导性自身免疫性肝炎与药物性肝损伤和自身免疫性肝炎患者临床特征比较研究[J]. 实用肝脏病杂志,2023,26(4):512-515.
[2] 窦晓光, 徐小元, 南月敏, 等. 2022年肝脏疾病研究进展[J]. 中华肝脏病杂志,2023,31(1):3-15.
[3] 李变利, 徐丽红. 药物性肝损伤、药物诱导性自身免疫性肝炎和自身免疫性肝炎鉴别诊断研究进展[J]. 实用肝脏病杂志,2021,24(4):460-463.
[4] Andrade R J, Aithal G P, de Boer Y S, et al. Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): an expert opinion meeting report[J]. J Hepatol,2023,79(3):853-866.
[5] Olivas I, Rodríguez-Tajes S, Londoño M C. Autoimmune hepatitis: challenges and novelties[J]. Med Clin (Barc),2022,159(6):289-298
[6] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 中华肝脏病杂志,2015,23(11):810-820.
[7] Yeong T T, Lim K H, Goubet S, et al. Natural history and outcomes in drug-induced autoimmune hepatitis[J]. Hepatol Res,2016,46(3):E79-E88.
[8] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015)[J].中华肝脏病杂志,2016,24(1):23-35.
[9] Tan C K, Ho D, Wang L M, et al. Drug-induced autoimmune hepatitis: a minireview[J]. World J Gastroenterol,2022,28(24):2654-2666.
[10] 凌珺, 朱冰, 陈威巍, 等. 半乳糖凝集素-9(Gal-9)介导的免疫调节作用在肝脏疾病中的研究进展[J]. 临床肝胆病杂志,2024,40(1):193-198.
[11] 刘茹佳, 辛小娟. 药物性肝损伤发生机制、危险因素、监测以及再用药的研究进展[J]. 临床肝胆病杂志,2023,39(4):968-973.
[12] 李变利, 彭颖, 杨柳, 等. 药物诱导性自身免疫性肝炎临床特征分析[J]. 中国临床药理学杂志,2021,37(17):2258-2261.
[13] Tsutsui A, Harada K, Tsuneyama K, et al. Histopathological analysis of autoimmune hepatitis with acute presentation: differentiation from drug-induced liver injury[J]. Hepatol Res,2020,50(9):1047-1061.
[14] Chalasani N P, Maddur H, Russo M W, et al. Practice parameters committee of the american college of gastroenterology. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury[J]. Am J Gastroenterol,2021,116(5):878-898.
[15] Mazza S, Soro S, Verga M C, et al. Liver-side of inflammatory bowel diseases: hepatobiliary and drug-induced disorders[J]. World J Hepatol,2021,13(12):1828-1849.
[16] Björnsson E S, Medina-Caliz I, Andrade R J, et al. Setting up criteria for drug-induced autoimmune-like hepatitis through a systematic analysis of published reports[J]. Hepatol Commun,2022,6(8):1895-1909.
[17] Weber S, Gerbes A L. Relapse and need for extended immunosuppression: novel features of drug-induced autoimmune hepatitis[J]. Digestion, 2023,104(3):243-248.
[18] Sirbe C, Simu G, Szabo I, et al. Pathogenesis of autoimmune hepatitis-cellular and molecular mechanisms[J]. Int J Mol Sci, 2021,22(24):13578.
[19] He T, Ren L, Gong M, et al. The progression of chronicity and autoimmune hepatitis in recurrent drug-induced liver injury[J]. Clin Res Hepatol Gastroenterol,2022,46(10):102009.
[20] Weber S, Gerbes A L. Challenges and future of drug-induced liver injury research-laboratory tests[J]. Int J Mol Sci,2022,23(11):6049.
[21] Hassoun J, Goossens N, Restellini S, et al. Discontinuation of immunosuppression in patients with immune-mediated drug-induced liver injury or idiopathic autoimmune hepatitis: a case-control study[J]. JGH Open,2023,7(2):135-140.
[22] Codoni G, Kirchner T, Engel B, et al. Histological and serological features of acute liver injury after SARS-CoV-2 vaccination[J]. JHEP Rep,2022,5(1):100605.