药物性自身免疫性肝炎（Drug-induced Autoimmune Hepatitis, DIAIH）作为药物性肝损伤（DILI）中具有挑战性的特殊类型，近年来在临床实践和基础研究中备受关注。Raul J. Andrade教授长期致力于DILI相关领域的研究，对于DIAIH的诊断、发病机制及治疗管理有着深入的见解。肝胆相照平台特别专访Andrade教授，聚焦药物性自身免疫性肝炎的诊断难点、与经典自身免疫性肝炎的鉴别要点以及未来研究方向，并将精彩内容整理成文，以飨读者。

问题一：关于不同类型自免肝的区别

肝胆相照：

药物性自身免疫性肝炎与经典自身免疫性肝炎有何主要区别？

What are the main differences between DIAIH and classic autoimmune hepatitis (AIH)?

Raul J. Andrade教授：

药物性自身免疫性肝炎（DIAIH）通常表现为急性肝炎的临床特征，而经典自身免疫性肝炎（AIH）往往可以有非常隐匿的起病过程，有时仅表现为轻度疲劳或实验室肝功能异常，甚至没有明显症状。因此，DIAIH 的表型更接近急性发作型的 AIH。

两者最重要的区别在于：DIAIH 患者在接受免疫抑制治疗后往往不会出现复发，而经典 AIH 患者停药后容易复发。此外，DIAIH 的肝组织炎症和纤维化可能更为明显，但这些并非特异性指标，不能单独作为鉴别标准。最关键的鉴别点是治疗后是否复发。

DIAIH typically presents with an acute hepatitis phenotype, whereas classic AIH often has a more insidious onset, sometimes with only mild fatigue or laboratory abnormalities. The key difference is that DIAIH patients usually do not relapse after immunosuppressive treatment, whereas classic AIH patients tend to relapse upon withdrawal of therapy. Liver histology in DIAIH may show more intense inflammation or fibrosis, but these are not definitive markers. The most reliable distinguishing feature is the sustained response without relapse after stopping treatment.

问题二：DIAIH的临床现状

肝胆相照：

DIAIH 是否存在特异性的临床、影像或免疫学标志物？

Are there any specific clinical, imaging, or immunological markers for DIAIH?

Raul J. Andrade教授：

目前尚未发现特异性的临床、影像或免疫学标志物可以用于 DIAIH 的诊断。一些新兴的分子研究显示，DIAIH 与经典 AIH 的肝活检病理特征可能存在某些差异，但这些数据仍处于早期，尚需进一步大样本验证。部分可溶性生物标志物如 IgG 亚型或某些多反应性抗体也被提出，但尚不能应用于日常临床。

There are no currently established clinical, imaging, or immunological markers that can definitively differentiate DIAIH. Some emerging molecular studies suggest potential differences in liver biopsy profiles between DIAIH and classic AIH, but these findings are still preliminary and need validation in larger cohorts. Some soluble biomarkers, such as IgG subtypes or polyreactive antibodies, have been proposed, but they are not yet clinically applicable.

问题三：治疗原则是否有差异

Question 3

肝胆相照：

DIAIH 的治疗原则与经典 AIH 是否相同？

Are the treatment principles for DIAIH similar to those for classic AIH?

Raul J. Andrade教授：

总体来说，治疗原则相似，主要是停用可疑损肝药物，必要时使用免疫抑制治疗（如糖皮质激素）。但与经典 AIH 不同的是，部分 DIAIH 患者可能不需要立即开始免疫抑制治疗，如果肝损伤较轻，可以先观察几天甚至几周，若肝功能自行改善，可避免使用免疫抑制药物。此外，即便需要治疗，也建议尽早减量，并尝试在 2-3 个月内停药。

The treatment principles are similar: discontinuation of the offending drug is crucial, and immunosuppressive therapy, usually with corticosteroids, may be needed. However, not all DIAIH patients require immediate immunosuppression. If liver injury is mild, it is acceptable to observe for a few days or weeks to see if there is spontaneous improvement. If immunosuppressive therapy is initiated, current guidelines recommend a faster taper and complete withdrawal within two to three months if possible.

问题四：未来的研究方向

Question 4

肝胆相照：

未来在 DIAIH 的诊断和治疗方面有哪些值得关注的研究方向？

What are the potential future research directions in the diagnosis and treatment of DIAIH？

Raul J. Andrade教授：

未来的研究重点应聚焦于寻找更可靠的生物标志物，以便更有效地区分 DIAIH 和经典 AIH。尽管目前药物性肝损伤整体缺乏特异性标志物，但分子水平的研究、疾病机制的深入了解、免疫通路的解析都将有助于找到更有前景的诊断和治疗靶点。同时，部分针对经典 AIH 的新型免疫治疗药物正在研发，未来可能也会适用于 DIAIH。

Future research should focus on identifying reliable biomarkers to distinguish DIAIH from classic AIH. Although specific biomarkers for DILI are still lacking in general, advances in molecular profiling and a deeper understanding of immune-mediated liver injury may provide valuable insights. Additionally, some novel immunosuppressive drugs currently in development for classic AIH might also be applicable to DIAIH in the future.