血清DBIL,TBIL,DBIL/TBIL检测在药物性肝损伤诊断中的应用

Application of Serum DBIL,TBIL,DBIL/TBI Detection in the Diagnosis of Drug-induced Liver Injury

目的分析血清直接胆红素(DBIL),总胆红素(TBIL),DBIL/TBIL检测在药物性肝损伤(DILI)诊断中的作用。方法选择陕西省人民医院2014年1月～2016年12月期间住院药物性肝炎患者作为目标人群,回顾性分析临床资料及实验室结果,提取与转归有关指标进行单因素及多因素分析。结果共有162例入组该研究,中药及中成药所致比例最高,约88例(54.3%),162例中肝细胞损伤型124例(76.5%),胆汁淤积型30例(18.5%),混合型8例(4.9%)。有效共120例(74.1%),未愈共41例(25.3%),死亡1例(0.6%)。黄疸,TBIL,DBIL,DBIL/TBIL作为未愈组独立预测因素。结论DILI的最常见病因是中药,以肝细胞型最多见,患者是否进展为慢性DILI,与黄疸、TBIL,DBIL水平相关。

Objective To analyze the functions of total bilirubin（TBIL）and direct bilirubin（DBIL）,DBIL/TBIL detection in the diagnosis of drug-induced liver injury（DILI）.Methods The clinical data and laboratory examination results of the pa-tients with drug-induced liver disease in Shaanxi Provincial People＇s Hospital were collected from January 2014 to December 2016.The factors were assessed by uni-variate and multivariate logistic regression analysis.Results In all,162 cases identi-fied as DILI were included in the study.The main causative group of drugs was Chinese herb（about 88 cases,54.3%）.A-mong these 162 cases,124 cases（76.5%）were hepatocellular damage type,30 cases（18.5%）cholestatic damage type and 8 cases（4.9%）mixed type damage.It showed that the complete recovery occurred in 120 patients（74.1%）and the non-re-covery occurred in 41（25.3%）,of which one death（0.6%）.The binary logistic regression analysis identified the jaundice, DBIL,TBIL and DBIL/TBIL as independent factors of the non-recovery of DILI.Conclusion The main causative group of drugs was Chinese herb and the hepatocellular damage type was the commonest one.What＆#39;s more,whether the case pro-gress into non-recovery one,was related to jaundice,TBIL,DBIL and DBIL/TBIL.