药物性肝损伤的临床与病理特点分析

An analysis of clinical and pathological features of 148 cases of drug-induced liver injury

目的探究药物性肝损伤患者的临床特点临床分型与病理损伤分型二者之间的联系。方法收集2018年1月至2022年12月南京市第二医院RUCAM>6分且行肝脏穿刺术患者的年龄、性别、用药史、出入院时间、肝功能指标及病理等资料。结果纳入148例患者,年龄为49.5岁,男女比例为1∶1.96。可疑肝伤损药物分别为中药、西药、中西药混合,所占比例分别为45.3%(67/148)、43.9%(65/148)、10.8%(16/148)。临床分型中,肝细胞损伤型60例(40.5%)。轻、中度肝损伤患者以炎症坏死型为主,重度及急性肝衰竭患者以胆汁淤积型为主。DILI的临床分型与病理分型相关性分析,Cramer’s V值为0.264(P<0.05)。结论病理分型与临床分型间具有一定的相关性,为中等相关。

Objective To analyze the clinical characteristics of drug-induced liver injury(DILI)patients with different clinical classifications and to compare the relationship between clinical and pathological classifications.Methods This study retrospectively screened DILI patients who underwent liver punctures with RUCAM>6 points in Nanjing Second Hospital from January 2018 to December 2022.Data of age,gender,medication history,disease course,liver function indexes and pathological results were collected.Results A total of 200 patients met the inclusion criteria,and 148 patients were included in the analysis after exclusion criteria.The median age of the 148 patients was 49.5 years.The male to female ratio was 1∶1.96.The drugs suspected of liver damage were divided into three categories,i.e.,traditional Chinese medicine,western medicine,and mixed Chinese and western medicine,accounting for 45.3%,43.9%and 10.8%of the cases,respectively.The main clinical classifications were hepatocellular injury(40.5%);The analysis of pathological classifications in DILI patients with different severities showed that inflammatory necrosis type was the main type among mild and moderate cases,and cholestatic type was mainly distributed in severe and acute liver failure cases.The correlation analysis between the clinical and pathological classifications of the DILI patients showed that the Cramer’s V coefficient value was 0.264(P<0.05).Conclusion There is a certain correlation between pathological and clinical classifications of DILI patients but the relationship is moderate.