老年药物性肝损伤患者血清自身抗体特征及其与肝生化指标和预后关系研究

A study on characteristics of serum autoantibodies and their relationship with liver biochemical indicators and prognosis in eld-erly patients with drug-induced liver injury

中文关键词: 老年  药物性肝损伤  自身抗体  肝生化指标  预后  受试者工作特征曲线  肝功能

英文关键词: elderly  drug-induced liver injury  autoantibody  liver biochemical indicator  prognosis  receiver operating characteristic  liver function

中文摘要:

      目的 分析老年药物性肝损伤(DILI)患者血清自身抗体特征,并研究其与肝生化指标和预后的关系.方法 选取2021年12月—2023年12月于华西医院诊治的老年DILI患者136例,使用间接免疫荧光法检测DILI患者血清自身抗体,并比较不同血清自身抗体特征DILI患者肝生化指标值和预后的差异,绘制受试者工作特征(ROC)曲线并分析自身抗体对DILI患者临床结局的评估价值.结果 136例老年DILI患者中,检出至少一项血清自身抗体阳性患者占72.06％(98/136),检出的血清自身抗体以ANA为主(63.24％),且患者抗体滴度主要为低、中滴度;自身抗体阳性组血清GGT水平高于自身抗体阴性组(P＜0.05),肝功能恢复正常比例低于自身抗体阴性组(68.37％vs92.11％,P＜0.05);ROC曲线显示,自身抗体阳性预测DILI患者不良临床结局的曲线下面积(AUC)为0.630,敏感度为91.18％,特异度为34.31％.结论 老年DILI患者血清中可检测到多种自身抗体,以ANA为主;自身抗体阳性与阴性患者的肝生化指标相似,但自身抗体阳性与肝功能恢复正常的概率较低,对此类指标的检测可能一定程度上预测不良临床结局.

英文摘要:

      Objective To analyze the characteristics of serum autoantibodies in elderly patients with drug-induced liver injury(DILI)and investigate their relationship with liver biochemical indicators and prognosis.Methods 136 elderly DILI patients diagnosed and treated in West China Hospital from December 2021 to December 2023 were enrolled.The levels of ser-um autoantibodies were detected by indirect immunofluorescence assay(IIFA).The differences in liver biochemical indicators and prognosis were compared among patients with different characteristics of serum autoantibodies.Receiver operating charac-teristic(ROC)curves were plotted to evaluate the value of autoantibodies in predicting the clinical outcomes of elderly DILI patients.Results Among the 136 elderly DILI patients,72.06％(98/136)were found to have at least one positive serum au-toantibody.Antinuclear antibody(ANA)was the most prevalent(63.24％),and the antibody titers were mainly low and me-dium titers.The level of serum gamma-glutamyl transferase(GGT)in the positive autoantibody group was higher than that in the negative autoantibody group(P＜0.05),the proportion of patients with normal liver function(68.37％)was lower than that in the negative autoantibody group(92.11％)(P＜0.05).ROC curve showed that the area under the curve(AUC),sensitivity and specificity of positive autoantibodies in predicting adverse clinical outcomes in elderly DILI patients were 0.630,91.18％and 34.31％,respectively.Conclusion A variety of autoantibodies can be detected in serum of elderly DILI pa-tients,and ANA is the main autoantibody.The liver biochemical indicators in elderly DILI patients with positive autoantibodies are similar to those with negative autoantibodies,but positive autoantibodies are not conducive to the normal recovery of liver function.The detection of these indicators may to some extent predict adverse clinical outcomes of elderly DILI patients.