2种药物性肝损伤诊断指南的应用分析

Clinical analysis of two diagnosis methods for herb-induced liver injury

为了比较我国中草药相关肝损伤临床诊疗指南(2016年)和药物性肝损伤诊治指南(2015年)对中药肝损伤诊断的一致性和差异性,该研究回顾性分析有可疑中草药或中成药服用史的药物性肝损伤患者390例,中药与西药联合用药的情况不纳入研究。应用我国药物性肝损伤诊治指南标准诊断的390例中药肝损伤病例中,极可能(>8分)14例(4%),很可能(6~8分)185例(47%),可能(3~5分)191例(49%)。将390例患者逐一应用中草药相关肝损伤临床诊疗指南标准进行判定,结果为确定诊断5例(占1%),临床诊断163例(占42%),疑似诊断222例(占57%)。2种诊断方法结果的总体一致性为43%,差异性为14%。该研究结果提示我国中草药相关肝损伤临床诊疗指南更适合中药肝损伤病例的诊断,由于回顾性病例研究有其局限性,有待进一步开展前瞻性研究。

To compare the consistency and difference of herb-induced liver injury between two methods in guidelines for clinical di- agnosis and treatment of liver injury related to Chinese herbal medicine in China （2016） and guidelines for the diagnosis and treatment of drug-induced liver injury in China（2015）. This retrospective analysis included 390 patients with herb-induced liver injury who had a history of suspicious Chinese herbal medicines or patent medicines ; the patients with integrative Chinese and western medicines were excluded from this study. The results indicated that there were 14（4% ） extremely probable patients （ 〉 8 points）, 185 （47%） highly probable patients （6-8 points） and 191 （49 % ） probable patients （ 3-5 points） in 390 cases with guidelines for diagnosis and treatment of drug-induced liver injury of China （2015）. While when guidelines for clinical diagnosis and treatment of liver injury related to Chi- nese herbal medicine in China （2016） was used for 390 patients, the results indicated that there were 5 （ 1% ） cases with l^toven diag- nosis, 163 （42%） cases with clinical diagnosis, and 222 （57%） cases with suspected diagnosis. Statistics showed that two methods had a consistency of 43% and difference of 14%. The research results showed that Guidelines for clinical diagnosis and treatment of liver injury related to Chinese herbal medicine in China（2016） was more suitable for the diagnosis of herb-induced liver injury. Due to the limitations of retrospective case study, further more prospective studies would be needed.