107例胆汁淤积性肝病的临床特征分析

Clinical features of cholestatic liver disease of 107 cases

目的分析胆汁淤积性肝病的临床特征,为临床加强该病的诊疗提供参考。方法回顾性分析2015年1月-2017年12月收治于厦门大学附属成功医院并确诊为胆汁淤积性肝病的107例患者的临床资料。计量资料2组间比较采用t检验。结果多数患者出现不同程度全身乏力、食欲不振、恶心、腹胀、皮肤瘙痒及黄疸等临床症状。按胆汁淤积部位分为肝内胆汁淤积64例(59. 8%)和肝外胆管淤积43例(40. 2%)。按病因分为胆总管结石21例(19. 6%),胆管寄生虫1例(0. 9%),原发性硬化性胆管炎2例(1. 9%),原发性胆汁性肝硬化3例(2. 8%),肝癌8例(7. 5%),胆管癌5例(4. 7%),胰腺癌4例(3. 7%),胰腺炎12例(11. 2%),病毒性肝炎28例(26. 2%),药物性肝损伤11例(10. 3%),酒精性肝炎6例(5. 6%),非酒精性脂肪性肝病4例(3. 7%),自身免疫性肝炎2例(1. 9%)。合并基础病患者的肝功能(ALT、AST、GGT、ALP、胆汁酸和TBil)明显差于单纯性胆汁淤积性肝病患者(t值分别为-3. 44,-2. 99,-2. 42,-4. 39,-3. 34,-2. 49,P值均<0. 05)。大多数患者经保肝、降酶、退黄等治疗后患者恢复良好。肿瘤患者预后不佳。结论胆汁淤积性肝病病因众多,临床特征无特异性,应引起足够重视。

Objective To investigate the clinical features of cholestatic liver disease （ CLD） ,and to provide a reference for strengtheningthe diagnosis and treatment of this disease. Methods A retrospective analysis was performed for the clinical data of 107 patients who wereadmitted to Chenggong Hospital Affiliated to Xiamen University from January 2015 to December 2017 and were diagnosed with CLD. The t -test was used for comparison of continuous data between groups. Results Most patients had the clinical symptoms of weakness,loss of appetite,nausea,abdominal distension,pruritus,and jaundice. According to the site of cholestasis,there were 64 patients （ 59. 8%）with intrahepatic cholestasis and 43 （ 40. 2%）with extrahepatic cholestasis. The cause of the disease was common bile duct stones in 21 patients（ 19. 6%） ,bile duct parasites in 1 patient （ 0. 9%） ,primary sclerosing cholangitis in 2 patients （ 1. 9%） ,primary biliary cirrhosis in 3 patients （ 2. 8%） ,liver cancer in 8 patients （ 7. 5%） ,bile duct carcinoma in 5 patients （ 4. 7%） ,pancreatic cancer in 4 patients （ 3. 7%） ,pancreatitis in 12 patients （ 11. 2%） ,viral hepatitis in 28 patients （ 26. 2%） ,drug - induced liver injury in 11 patients （ 10. 3%） ,alcoholic hepatitis in 6 patients （ 5. 6%） ,nonalcoholic fatty liver disease in 4 patients （ 3. 7%） ,and autoimmune hepatitis in 2 patients（ 1 9%） . The CLD patients with underlying diseases had a significantly poorer liver function （ alanine aminotransferase, aspartate aminotransferase,gamma - glutamyl transpeptidase,alkaline phosphatase,bile acid,and total bilirubin）than those with CLD alone （ t = - 3. 44,- 2. 99,- 2. 42,- 4. 39,- 3. 34,and - 2. 49,all P 〈 0. 05） . Most of the patients achieved good recovery after liver - protecting,transaminase - lowering,and jaundice clearance treatment. The patients with tumors had poor prognosis. Conclusion CLD has various causes,and its clinical features lack specificity. Clinicians should pay enough attention to this disease.