Comparison of Clinical and Pathologic Features of Antimitochondrial Antibodies-negative Primary Biliary Cirrhosis and Cholestatic Type Drug-induced Liver Injury

Aim: To compare the respective clinical and pathologic features of antimitochondrial antibodies-negative (AMA-negative) primary biliary cirrhosis (PBC) and cholestatic type drug-induced liver injury (DILI) for clinical differential diagnosis. Patients and Methods: Clinical data from 23 patients with AMA-negative PBC and 39 patients with cholestatic type DILI, treated at our hospital between January 2013 and January 2024, were collected and retrospectively analyzed. Results: The cholestatic type DILI group exhibited a higher incidence of malaise and abdominal pain compared with the AMA-negative PBC group. Alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, low-density lipoprotein cholesterol, globulin, immunoglobulin G, immunoglobulin M, and anti-gp210/anti-Sp100 antibodies were higher in the AMA-negative PBC group compared with the cholestatic type DILI group. There were differences in the stages of inflammation and fibrosis between the cholestatic type DILI group and the AMA-negative PBC group. Lymphocyte and plasma cell infiltration in the confluent areas was more pronounced in the AMA-negative PBC group, while monocyte infiltration was greater in the cholestatic type DILI group. In the small bile duct reaction, the positive rate was higher in the AMA-negative PBC group compared with the cholestatic DILI group. Conversely, the positive rate of D-PAS staining was greater in the cholestatic type DILI group than in the AMA-negative PBC group. All of these differences were statistically significant ( P < 0.05). Conclusions: Comparing the AMA-negative PBC with the cholestatic type DILI revealed differences in liver function, lipid profiles, immunoglobulins, autoantibodies, and hepatic histopathologic features. These distinctions facilitate the clinical differentiation between the 2 conditions.