药物性肝损伤患者的临床特点及CT影像学表现分析

Clinical Features and CT Imaging Findings of Drug-induced Liver Injury

目的分析85例药物性肝损伤(DILI)患者的临床特点及CT影像学表现,以期为临床预防、诊治提供参考。方法全部病例资料来源于2010年1月至2018年7月我院确诊的DILI患者,共计85例,对所有患者性别、年龄、病史、用药史、临床特征、临床分型及肝功能生化指标、CT检查结果等进行回顾性分析。结果本组患者男女比例为1:1.18,以41-60岁年龄段居多,占73.75%;临床表现以纳差、乏力、上腹部不适、食欲下降最为常见。DILI患者中,三种以上联合用药占比最高,其次为中药、抗生素类药、抗病毒药、非甾体抗炎药。DILI临床分型以肝细胞型为主,其次为胆汁淤积型,混合型最少。肝细胞型DILI混合型丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)水平明显高于胆汁淤积型(P<0.05),三种分型谷氨酰转移酶(GGT)无明显差异(P>0.05)。CT显示DILI类型以弥漫性肝损伤、局灶性肝损伤为主,分别占52.94%、43.53%,多灶性肝损伤较少见,仅占3.53%;三者CT值依次为31-42Hu、41-49Hu、45-51Hu,CT依次显示为肝实质密度降低、多发小片状低密度病灶、多灶性低密度斑片影。结论①DILI可发生于各年龄段人群,临床表现无特异性,引起DILI的药物种类繁多,故临床使用药物治疗疾病时应注重用药安全;②DILI临床分型多为肝细胞损伤型,CT影像表现具有一定特征,对临床诊断有一定参考价值。

Objective To analyze the clinical features and CT imaging findings of85 patients with drug-induced liver injury(DILI)to provide references for clinical prevention, diagnosis and treatment. Methods A total of 85 patients with DILI diagnosed in the hospital from January 2010 to July 2018 were included in the study. Gender, age,medical history, medication history, clinical features, clinical classification, biochemical indicators of liver function and CT findings were analyzed retrospectively. Results The ratio of male to female in this study was 1:1.18, and most patients were between 41 and60 years old, accounting for 73.75%. The most common clinical manifestations included poor appetite, fatigue, upper abdominal discomfort and loss of appetite. Among the patients with DILI, the proportion of three or more combinedmedication was the highest,followed by traditional Chinese medicines, antibiotics, antiviral drugs and non-steroidal anti-inflammatory drugs. The main clinical type of DILI was hepatocyte type, followed by cholestasis typeand the mixed type. The levels of alanine aminotransferase(ALT) and aspartate aminotransferase(AST) in hepatocytetype and mixed type were significantly higher than those in cholestasis type(P<0.05), but there was no significant difference in the level of glutamyl transferase(GGT) among the three types(P>0.05). CT showed that main types of DILI were diffuse liver injury and focal liver injury, accounting for 52.94%and 43.53%, respectively. Multifocal liver injury was rare, accounting for only 3.53%.The CT number of the them were 31~42 Hu, 41~49 Hu and 45~51 Hu, respectively. CT showed decreased liver parenchyma density, multiple small patchy low-density lesions and multifocal low-density patchy shadow. Conclusion DILI occur in all ages, and the clinical manifestations are not specific. The drugs causing DILI are various. Therefore, clinical use of drugs should focus on medication safety when treating diseases. The main clinical type of DILI is hepatocyte injury, and the CT image is characteristic, which is of certain reference value for clinical diagnosis.