摘要
目的深入分析药物性肝损伤(drug-induced liver injury,DILI)的临床及病理特征,为其早期发现与准确诊断提供有力的支持,并对其预后结果进行初步探讨。方法采用回顾性分析方法,收集无锡市第五人民医院2019年1月至2023年3月收治的123例经肝组织穿刺活检确诊为DILI病例。详细统计患者的年龄、性别、基础疾病情况、可疑药物种类、DILI的分型与分级、血清学指标及病理结果。根据临床分型、严重程度分级以及不同可疑药物进行分组,对比研究不同组别患者之间各项指标的差异。结果123例DILI患者中,男46例,女77例,其中≥40岁患者100例。主要可疑药物包括中成药及中药类(25.45%)、降压药(14.79%)、抗肿瘤药(7.10%)等。在临床表现方面,DILI患者并未展现出明显的特异性。在临床分型中,以肝细胞损伤型为主,共80例;肝细胞型与混合型患者在ALT、AST水平存在显著性差异(P<0.05),而肝细胞型与胆汁淤积型患者在ALT、AST、GGT水平上也表现出显著性差异(P<0.05)。三种临床分型在严重程度方面并未展现出显著性差异。结论DILI的临床表现不具备明显的特异性。中成药及中药类、降压药和抗肿瘤药物是引发DILI的主要药物类型。DILI患者肝组织会出现不同程度的炎症细胞浸润、肝细胞肿胀及坏死。临床中,对于DILI的识别与治疗应给予足够的重视,及时发现并予以治疗,确保患者能及时停用可疑药物,以改善患者的预后。
Objective The clinical and pathological characteristics of drug-induced liver injury(DILI)were analyzed in order to provide strong support for its early detection and accurate diagnosis.Methods In this study,123 patients diagnosed with DILI by liver biopsy admitted to the Fifth People′s Hospital of Wuxi from Jan.2019 to Mar.2023 were collected by retrospective analysis.The patients′age,sex,underlying diseases,suspected drugs,types and grades of DILI,serological indexes and pathological results were analyzed in detail.According to the clinical classification,severity grade and different suspicious drugs were divided into groups,and the differences of various indicators between different groups of patients were compared.Results Among the 123 patients with DILI,46 were males and 77 were females,of which 100 were over 40 years old.The main suspected drugs included traditional Chinese medicine(25.45%),antihypertensive drugs(14.79%),antitumor drugs(7.11%),etc.In terms of clinical manifestations,DILI patients did not show significant specificity.In clinical classification,mainly liver cell injury type,a total of 80 cases.There were significant differences in ALT and AST levels between hepatocellular type and mixed type patients(P<0.05),and there were also significant differences in ALT,AST and GGT levels between hepatocellular type and cholestasis type patients(P<0.05).There was no significant difference in severity among the 3 clinical classifications.Conclusion The clinical manifestations of DILI do not have obvious specificity.Traditional Chinese medicine,antihypertensive drugs and antitumor drugs are the main types of drugs that cause DILI.The liver tissue of DILI patients will show different degrees of inflammatory cell infiltration,hepatocyte swelling and necrosis.In clinical practice,sufficient attention should be paid to the identification and treatment of DILI,timely detection and treatment should be given to ensure that patients can stop the suspected drugs in time to improve the prognosis of patients.
作者
郭雨欣
陆忠华
GUO Yuxin;LU Zhonghua(Wuxi Clinical College of Nantong University,Wuxi 214000;Department of Hepatology,the Fifth People′s Hospital of Wuxi,China)
出处
《胃肠病学和肝病学杂志》
2025年第9期1334-1339,1347,共7页
Chinese Journal of Gastroenterology and Hepatology
基金
无锡市医学重点学科建设项目-创新团队(CXTD202100)
太湖人才计划(20200803)。
关键词
药物性肝损伤
临床特征
病理特征
可疑药物
回顾性分析
Drug-induced liver injury
Clinical features
Pathological features
Suspicious drugs
Retrospective analysis
