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中西药肝损伤临床及病理特征分析 被引量:4

Analysis of clinical and pathological characteristics of liver injury induced by Chinese and western medicine based on integrated evidence chain
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摘要 目的分析中西药导致肝损伤的临床及病理特征。方法回顾性分析2015年1月至2020年12月解放军总医院第五医学中心药物性肝损伤住院患者的一般情况、临床分型、用药史、实验室指标和肝穿刺病理特征。结果化学药物肝损伤(DILI)患者102例,男27例、女75例,年龄为(47±13)岁;中药肝损伤(HILI)患者187例,男50例、女137例,年龄为(49±11)岁。两组在性别、年龄、BMI、过敏史、饮酒史等方面差异无统计学意义。在临床分型方面,DILI和HILI均以肝细胞损伤型最多见,分别为83例(81.4%)和139例(74.3%)。HILI组碱性磷酸酶(ALP)为171.0(139.0,242.0)U/L、胆红素(TBil)为96.6(33.0,209.9)μmol/L,高于DILI组ALP 150.0(110.8,246.8)U/L、TBil 73.9(20.2,148.3)μmol/L,差异有统计学意义(P<0.05)。肝细胞损伤型中HILI组ALT为895.0(491.0,1312.0)U/L、ALP为161.0(125.0,200.0)U/L,高于DILI组ALT 541.0(236.0,1032.0)U/L、ALP 142.0(107.0,195.0)U/L,差异有统计学意义(P<0.05);混合型中DILI组ALT为(278.3±111.9)U/L、ALP为296.0(202.0,501.5)U/L、γ-谷氨酰转肽酶(γ-GT)为(563.9±304.9)U/L、肌酐为89.0(64.5,101.5)μmol/L,高于HILI组ALT(199.4±62.3)U/L、ALP 222.0(167.5,248.0)U/L、γ-GT为(198.1±119.4)U/L、肌酐62.0(54.0,77.5)μmol/L,差异有统计学意义(P<0.05)。DILI组中可疑损肝药物为解热镇痛药排第1位,其次为治疗甲状腺疾病药物。导致HILI的中药主要应用于保健、皮肤疾病、消化系统疾病、骨关节疾病等。肝脏病理方面,肝细胞损伤型DILI较HILI更易出现肝细胞大片坏死、吞噬色素颗粒的库普弗细胞、肝细胞和(或)胆管内胆汁淤积,差异有统计学意义(P<0.05)。结论DILI与HILI临床肝损伤类型均以肝细胞损伤型为主,尽管DILI组ALT和ALP低于HILI,但肝脏损伤的病理表现更严重。 Objective To analyze the clinical and pathological features of liver injury caused by Chinese and western medicine.Methods The general situation,clinical classification,medication history,laboratory indicators and pathological characteristics of liver puncture of in patients with drug-induced liver injury(DILI)admitted to our hospital from January 2015 to December 2020 were retrospectively analyzed.Results There were 102 patients with DILI,27 males and 75 females,with an average age of(47±13)years.There were 187 patients with herb-induced liver injury(HILI),including 50 males and 137 females,with an average age of(49±11)years.There was no statistically significant difference between two groups in gender,age,body mass index(BMI),allergic history and drinking history.Both DILI and HILI were hepatocellular injury type,the numbers were 139(74.3%)and 83(81.4%),respectively.The levels of initial alkaline phosphatase(ALP)171.0(139.0,242.0)U/L and total bilirubin(TBil)96.6(33.0,209.9)umol/L of HILI group were higher than those of DILI group[initial ALP 150.0(110.8,246.8)U/L,initial TBil 73.9(20.2,148.3)umol/L],which was statistical significance(P<0.05).The levels of initial alanine aminotransferase(ALT)895.0(491.0,1312.0)U/L and initial ALP 161.0(125.0,200.0)U/L of hepatocellular injury type in HILI group were higher than those in DILI group[initial ALT 541.0(236.0,1032.0)U/L,initial ALP 142.0(107.0,195.0)U/L],which was statistical significance(P<0.05).The levels of initial ALT 278.3±111.9 U/L,initial ALP 296.0(202.0,501.5)U/L,initial gamma-glutamyltransferase(GGT)563.9±304.9 U/Land creatinine(Cr)89.0(64.5,101.5)umol/Lof mixed injury type in DILI group were higher than those in HILI group[initial ALT 199.4±62.3 U/L,initial ALP 222.0(167.5,248.0)U/L,initial GGT 198.1±119.4 U/L,Cr 62.0(54.0,77.5)umol/L],which was statistical significance(P<0.05).In DILI group,the first suspected drugs inducing liver injury was antipyretic and analgesic,followed by drugs for thyroid diseases.Chinese medicines inducing HILI were mainly used in health care,skin disease,digestive system disease,bone and joint disease,etc.Compared to hepatocellular injury HILI,necrosis of liver cells,phagocytic pigment granules Kupffer cells,cholestasis in hepatocytes and/or the bile duct more likely occurred in hepatocellular injury DILI,which was statistical significance(P<0.05).Conclusion Hepatocyte injury is the main type of both DILI and HILI.Although the levels of initial ALT and ALP of DILI are lower than those of HILI,the pathological manifestations of liver injury is more severe in DILI.
作者 何婷婷 王丽苹 任璐彤 崔延飞 柏兆方 郭玉明 宫嫚 王睿林 HE Ting-ting;WANG Li-ping;REN Lu-tong;CUI Yan-fei;BAI Zhao-fang;GUO Yu-ming;GONG Man;WANG Rui-lin(Department of Traditional Chinese Medicine,the Fifth Medical Center of PLA General Hosptial Beijing 100039,China;Institute of Liver Disease,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Clinical Pharmacy,People's Hospital of Inner Mongolia Autonomous Region,Huhhot 010000,China;Department of Hepatobiliary Stomach Spleen Surgery,the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)
出处 《肝脏》 2021年第9期962-967,共6页 Chinese Hepatology
基金 国家自然科学基金资助项目(NO.81673806) 保健专项科研课题(NO.17BJZ53) 国家十三五科技重大专项课题(2018ZX10303502-022-019)。
关键词 中药 西药 肝损伤 临床特征 病理 整合证据链 Chinese herbal medicine Western medicine Liver injury Clinical characteristics Pathology Integrated evidence chain
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