药物性肝损伤诊断评分系统的比较及应用体会

Comparing and improvements on the diagnostic criterion of drug-induced liver injury

目的:分析比较药物性肝损伤(DILI)因果关系评价表(RUCAM)及临床诊断量表(CDS)评分系统的一致性及优缺点,并进行应用评价。方法:回顾分析33例DILI病例,分别应用RUCAM及CDS评分系统进行量化评分,提出对评分系统的改进意见,并进行应用比较。结果:33例DILI病例,RUCAM系统评分提示高度可能和可能性大者25例(75.76%),显著高于CDS系统评分中确定和可能性大的16例(48.48%)(P<0.01)。采用我们建议的RUCAM评分系统评判,确定诊断及可能性大者占87.88%(29/33),显著高于RUCAM评分系统的75.76%(P<0.01)。结论:RUCAM评分系统较CDS评分系统的临床一致性高。改良RUCAM评分系统更有助于提高DILI的诊断率。

Objective：To investigate the congruity,advantages and disadvantages between clinical diagnostic scale（CDS）and Roussel Uclaf causality assessment method（RUCAM）scale,and establish the improved RUCAM scale which was evaluated in clinical application to perfect the diagnosis of drug-induced liver injury（DILI）.Methods：Thirty three DILI patients were enrolled.Each case was assessed with CDS and RUCAM scale by the same investigator and requirements of each system.Finally,suggestions of improvement were advanced to RUCAM scale.Results：The RUCAM showed DILI diagnosis rate was 75.76%,which was 48.48% in CDS.The diagnosis rate of the improved RUCAM scale was 87.88% and significantly higher than both of them（P0.01）.Conclusion：Comparing with two clinical scales,the RUCAM scale produced assessment closer to clinical diagnosis,whereas the improved RUCAM was discriminative power and closer than the primitive one.