摘要
目的探讨药物性肝损伤(DILI)的临床特点,评价RUCAM表及Maria诊断标准临床应用价值。方法回顾性分析2007年至2011年在大连医科大学附属第一医院因DILI住院患者107例的致病药物、临床表现及治疗转归。运用Spearman相关分析和配对χ2检验,评价RUCAM表及Maria诊断标准的一致性及与临床判断的符合率。结果引起肝损伤的药物多见于中药、抗肿瘤药物、抗甲状腺药物、抗生素和抗结核药物。肝损伤临床类型为肝细胞型81例,胆汁淤积型11例,混合型12例。RUCAM表及Maria评分系统结果完全符合有34例(31.7%),相差1级48例(44.8%),相差2级19例(17.7%),表示两者有一定的正相关(r=0.233,P=0.015)。结论 DILI患者中以中药、抗肿瘤药及抗甲状腺药常见;临床类型以肝细胞型多见;RUCAM表的DILI因果关系评价更接近一般临床判断。
Objective To investigate the clinical features of drug-induced liver injury （DILI） and evaluate the RUCAM and Maria diagnostic criteria for clinical applications, in order to improve people＇s understanding and the level of di- agnosis and treatment of drug-induced liver disease. Methods Drug-induced liver injury patients which were admitted to the First Affiliated Hospital of Dalian Medical University from 2007-2011, were reviewed retrospectively. The etiology, clinical manifestations and treatment outcomes were recorded. Spearman relative analysis and paired X^2 test were used to evaluate the consistency and clinical judgment accuracy of RUCAM and Maria diagnostic criteria. Results Liver damage was caused by herbal drug, antineoplastic agents, antithyroid drugs, antibiotics and anti-tuberculous drugs, which are most common in current drugs list. There were 81 cases of liver cell type（75.7%）;absolute agreement between the 2 scales was observed in 34 cases（31.7%）,with disagreement of 1 level in 48 cases（44.8%）,and of 2 levels in 19 cases（17.7%）,which showed a positive correlation（r= 0. 233 , P = 0. 015）. Conclusion DILI was caused by various medicine, especially herbal drugs, antineoplastic agents and anti-thyroid drugs. The liver cell type was the most commonclinical type in DILI. The RUCAM scale showed better discriminative power and produced assessments closer to clinical determinant.
出处
《肝脏》
2012年第12期846-848,共3页
Chinese Hepatology
关键词
药物性损伤
诊断
临床分型
RUCAM表
Drug-induced liver injury
Diagnosis
Clinical classification ； RUCAM
