由于阿托瓦斯塔丁的药物诱导的自身免疫性肝炎:一个复杂的临床病例和文献综述
Nancy H Serrano-Pérez1,2, Jeanete S Rodríguez-Martínez1,2, Sandra M Feria-Agudelo1,2
1School of Medicine, National Autonomous University of Mexico, Escolar 411A, Copilco Universidad, Coyoacán, Mexico City, 04510, Mexico.
Gastroenterology report
|March 9, 2026
概括
本案例研究突出了具有自身免疫特征的药物诱导性肝损伤 (DILI),特别是他类药物诱导的自身免疫性肝炎. 使用诸如罗塞尔·乌克拉夫因果关系评估方法 (RUCAM) 等工具进行早期诊断对于迅速治疗和恢复至关重要.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 临床药理学 临床药理学
- 免疫学 免疫学 免疫学
背景情况:
- 药物诱导性肝损伤 (DILI) 可以呈现出自身免疫性特征,模仿自身免疫性肝炎.
- 虽然他类药物通常是安全的,但很少与肝毒性有关,这种肝毒性在组织学上类似于自身免疫性肝炎.
- 诊断自身免疫性DILI可能具有挑战性,特别是在血清阴性病例中.
研究的目的:
- 在患有慢性病的患者中描述阿托瓦斯塔丁诱导的自身免疫性类似肝炎病例.
- 强调诊断工具对于在血清阴性呈现中识别药物诱导的自身免疫性肝炎 (DIAIH) 的重要性.
- 突出通过适当治疗引起的类他类自身免疫性肝炎的潜在可逆性.
主要方法:
- 一名患有慢性病的53岁妇女在开始服用阿托瓦斯塔丁后出现肝损伤.
- 实验室测试显示混合性肝损伤;病毒,自身免疫和代谢标志物是负的.
- 肝活检显示了自身免疫性肝炎的特征;使用了因果关系评估工具 (RUCAM,S-AIH得分).
主要成果:
- 患者出现了黄和右上象限疼痛,肝功能测试恶化.
- 肝脏活检与自身免疫性肝炎相容,成像排除了胆道阻塞.
- 6的RUCAM和简化自身免疫性肝炎 (S-AIH) 评分支持阿托瓦斯塔丁作为自身免疫性肝炎的原因.
结论:
- 药物诱导的具有自身免疫特征的肝损伤应考虑在患者在他类药物暴露后有不明原因的肝损伤.
- 在血清阴性患者中,肝活检和结构性因果关系评估工具 (RUCAM,S-AIH) 对于诊断DIAIH至关重要.
- 及时的免疫抑制疗法,如皮质类固醇,可以导致显著的临床和生化改善在他类药物诱导的自身免疫性类似肝炎.
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