不同类型急性药物性肝损伤的临床特点分析

Analysis of the Clinical Characteristics of Different Types of Drug-induced Acute Liver Injury

目的:分析不同类型急性药物性肝损伤的药物种类、生化学特点及病理学特征。方法:采用回顾性研究方法,总结分析急性药物性肝损伤的临床分型、药物种类、临床表现、生化学指标及病理学特征。结果:209例急性药物性肝损伤患者最常见的致肝损伤药物为中药(45.93%),其次为解热镇痛药(NSAIDs)(15.31%)、抗生素(11.96%)。最常见的临床症状包括乏力(72.25%)、纳差(62.68%)、尿黄(61.72%);三种临床类型间的临床症状比较,差异无统计学意义(P>0.05)。三种临床类型间生化学指标(ALT、AST、ALP、GGT、TBIL、DBIL)比较,差异有统计学意义(P<0.05)。病理学特征主要为肝细胞点灶状坏死(94.26%)、混合性炎细胞浸润(83.73%)、凋亡小体(82.30%)、纤维组织增生(68.90%)、肝细胞水样变性(60.29%)。三种临床类型间肝细胞或Kuffer细胞内色素颗粒沉着、融合性坏死及肝细胞和(或)毛细胆管淤胆比较,差异均有统计学意义(P<0.05),其他病理特征比较,差异均无统计学意义(P>0.05)。结论:中药已成为目前药物性肝损伤的主要病因;现用临床分型标准尚需要进一步研究完善。

Objective： To analyze the drug types,biochemical and pathologic characteristics of different types of drug-induced acute liver injury（DILI）.Methods： 209 cases of drug-induced acute liver injury diagnosed clinically in the 302 hospital of PLA were retrospectively studied.The drugs which induced liver injuries were summarized and analyzed.The clinical classification,medications,clinical characters,biochemical parameters,and pathologic characters of 209 cases were collected and analyzed.Results： The top three drugs which induced liver injuries in the 209 patients were arranged in order of their usage frequencies： traditional Chinese herbs（45.93%）,antipyretic analgesics（NSAIDs）（15.31%） and antibiotics（11.96%）.The common symptoms included fatigue（72.25%）,poor appetite（62.68%） and jaundice（61.72%）.There was no significant difference in common symptoms among three clinical types（P0.05）.There were significant differences in biochemical parameters.including alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,alkaline phosphatase（ALP）,γ-glutamyl transpeptidase（GGT）,total bilirubin（TBIL） and direct bilirubin（DBIL） among three clinical types（P0.05）.The top six pathologic characteristics of DILI were arranged in order of their frequencies： spotted and focal necrosis of hepatocytes（94.26%）,mixed inflammatory cell infiltration（83.73%）,apoptosis body（82.30%）,fibroplasticproliferation（68.90%） and hydropic degeneration of hepatocytes（60.29%）.There was significant difference in pigment particle calm in hepatocytes or Kuffer cells,confluent necrosis and cholestasis among three clinical types（P0.05）.There was no difference in other pathologic characters among three clinical types（P0.05）.Conclusion： Chinese herbs had become the main cause of DILI.Some modifications of the criterion of clinical classification of DILI were necessary.