Nisan 2015

Otoimmun hepatit ve ilaca bagli karaciger hasari ayirici tanisinda karaciger biyopsisinin rolü

The role of liver biopsy in the differential diagnosis of autoimmune hepatitis and drug-induced liver injury

Ana Sayfa
Sayılar
Nisan 2015
Otoimmun hepatit ve ilaca bagli karaciger hasari ayirici tanisinda karaciger biyopsisinin rolü...

Yazarlar

Süleyman COSGUN ¹ , Hülya AKAN ², Hakan DEMIRDAG ³ , Ecenur ÇINAR ² , Kamil ÖZDIL ³ , Haci Mehmet SÖKMEN ³

Kurumlar

¹Department of Gastroenterology, Dumlupinar University, School of Medicine, Kütahya ² Department of Family Medicine, Yeditepe University, School of Medicine, Istanbul ³ Department of Gastroenterology, Ümraniye Education and Research Hospital, Istanbul

Sayfa Numaraları

5-9

Makale Türü

Özgün Arastirma

Anahtar Kelimeler

Otoimmün hepatit, ilaca bagli karaciger hasari, ayirci tani

Keywords

Autoimmune hepatitis; differential diagnosis; drug-induced liver injury

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Özet

Giris ve Amaç:Amacimiz otoimmün hepatit ve ilaca bagli karaciger hasarinin ayirici tanisinda histolojik özellikleri, potansiyel ayirt ettirici histolojik belirteçleri ve karaciger biyopsisinin degerini incelemektir. Gereç ve Yöntem:Klinik olarak iyi tanimli otoimmün hepatit ve ilaca bagli karaciger hasari olan vakalardan alinan 39 karaciger biyopsisini de-gerlendirdik. Roussel Uclaf Causality Assessment Method kullanilarak, sadece çok yüksek olasilikli, ya da yüksek olasi olarak degerlendirilen vakalar çalismaya dahil edildi. Laboratuvar sonuçlari retrospektif olarak elde edildi. Bulgular:Otoimmüun hepatit ve ilaca bagli karaciger hasari olan hastalar arasinda immünglobulin G, demir ve ferritin düzeyleri arasinda istatistiksel olarak anlamli fark bulunmustur. Lenfosit, eozinofil, interface hepatit, lobüler hepatit, zon 3 nekroz, birlesme nekrozu, rozet formasyonu ve fibrozis derecesi açisindan gruplar arasinda fark yoktur. Plazma hücresi seviyesi bakimindan iki grup arasinda istatistiksel olarak anlamli bir farklilik vardir. Sonuç:Patolojik olarak sadece plazma hücre düzeyleri otoimmün hepatit ve ilaca bagli karaciger hasarini ayirt etmede yardimcidir. Bu nedenle, otoimmün hepatit ve ilaca bagli karaciger hasari ayirci tanisinda plazma hücre düzeylerine ek olarak serum ferritin, demir ve immünglobulin G düzeyleri kullanilabilir. Iki grup arasinda monosit oranlari anlamli dercede farklidir ve bu bulgunun daha ileri arastirmalarla desteklenmesi gereklidir.

Abstract

Background and Aims:Our goal was to determine the histological properties, potential differentiating histological markers and the value of a liver biopsy in the differential diagnosis of autoimmune hepatitis and drug-induced liver injury. Materials and Methods: Forty-seven liver biopsies from patients with clinically well-defined autoimmune hepatitis and drug-induced liver injury were assessed. Only very highly probable or highly probable cases, according to the Roussel Uclaf Causality Assessment Method, were included in the study. The laboratory results were reviewed retrospectively. Results:The blood levels of immunoglobulin G, iron and ferritin were significantly different between patients with autoimmune hepatitis and drug-induced liver injury. Statistically, there was no significant difference between the groups regarding lymphocyte and eosinophil levels, piecemeal necrosis, confluent necrosis and zone 3 necrosis, badge formation levels or the stage of fibrosis. However, there was a significant difference between the two groups in plasma cell levels. Conclusions:Only plasma cell levels are pathologically useful in distinguishing autoimmune hepatitis and drug-induced liver injury. Therefore, serum ferritin, iron and immunoglobulin G values, in addition to plasma cells levels, can be used in differential diagnosis of autoimmune hepatitis and drug-induced liver injury. The percentage of monocytes is significantly different between these groups, and this finding should be further investigated.