药物性肝损伤临床分型特点及其与肝组织学改变的关系

徐曾丽; 高敏; 郭春霞; 邢敏丹; 李嘉

doi:10.3969/j.issn.1001-5256.2017.05.027

药物性肝损伤临床分型特点及其与肝组织学改变的关系

DOI: 10.3969/j.issn.1001-5256.2017.05.027

1. 天津医科大学研究生院
2. 天津市第二人民医院
3. 天津市肝病医学研究所

基金项目:

天津市卫生计生委科技基金项目(2015KZ011)；

详细信息

中图分类号: R575
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出版历程
- 出版日期: 2017-05-20

Clinical features of different types of drug-induced liver injury and their association with liver histological changes

Graduate School of Tianjin Medical University

Research funding:

摘要

摘要:
目的分析不同临床分型药物性肝损伤（DILI）患者的临床特征,并比较临床分型与病理损伤分型的关系。方法收集2014年1月-2016年1月天津市第二人民医院收治的289例DILI患者,依据生化指标计算"R值"将DILI临床分型分为:肝细胞损伤型、胆汁淤积型和混合型,分别统计其用药情况、生化指标,并对行肝脏病理检查患者的肝组织学改变进行分析,比较其病理损伤类型与临床分型的一致性。非正态分布的计量资料多组间比较采用非参数Kruskal-Wallis H检验;正态分布的计量资料多组间比较采用单因素方差分析。计数资料组间比较采用χ2检验。结果依据R值将289例DILI患者分为:肝细胞损伤型181例（62.63%）、胆汁淤积型55例（19.03%）以及混合型53例（18.34%）。其中致肝损伤的药物以中（草）药所占比例最大（48.79%）。共152例患者行肝脏病理检查,依据组织学改变情况分为:肝细胞损伤型43例（28.29%）,胆汁淤积型8例（5.26%）,混合型101例（66.45%）;该152例患者依据R值的临床分型为:肝细胞损伤型95例（62.50%）,胆汁淤积型29例（...
- 药物性肝损伤 /
- 病理学,临床 /
- 组织学
Abstract:
Objective To investigate the clinical features of patients with different clinical types of drug-induced liver injury (DILI) , as well as the association between clinical type and pathological type.Methods A total of 289 patients with DILI who were admitted to Tianjin Second People's Hospital from January 2014 to January 2016 were enrolled, and according to the“R value”calculated based on biochemical parameters, they were divided into hepatocellular injury type group, cholestasis type group, and mixed type group.Medications and biochemical parameters were summarized and the liver histological changes in patients undergoing biopsy were observed to investigate the consistency between pathological type and clinical type.The non-parametric Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and a one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups.The chi-square test was used for comparison of categorical data between groups.Results According to the calculated“R value”, of all patients, 181 (62.63%) had hepatocellular injury type, 55 (19.03%) had cholestasis type, and 53 (18.34%) had mixed type.Most of the drugs that caused liver injury were traditional Chinese medicine (48.79%) .A total of 152 patients underwent biopsy, and according to the histological changes, 43 (28.29%) had hepatocellular injury type, 8 (5.26%) had cholestasis type, and 101 (66.45%) had mixed type;among these patients, the calculation of the “R value”showed that 95 (62.50%) had hepatocellular injury type, 29 (19.08%) had cholestasis type, and 28 (18.42%) had mixed type.There was a poor consistency between pathological type and clinical type (κ=0.229, P<0.05) .Conclusion Traditional Chinese medicine is the main cause of DILI.There is a poor consistency between clinical type and pathological type of DILI, and the most common pathological type is mixed type.Therefore, the criteria for clinical typing await further improvement.
- drug-induced liver injury /
- pathology, clinical /
- histology

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参考文献(12)

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