药物性肝损伤的临床与病理特点分析

肝脏 ›› 2023, Vol. 28 ›› Issue (11): 1280-1284.

药物性肝损伤的临床与病理特点分析

王双双, 熊清芳, 胡一帆, 陈妙洋, 杨永峰

211166 江苏南京医科大学公共卫生学院(王双双);210003 南京中医药大学附属南京医院(南京市第二医院)肝病科(熊清芳,胡一帆,陈妙洋);210003 南京医科大学公共卫生学院教学医院(南京市第二医院)肝病科(杨永峰)

收稿日期:2023-06-30 出版日期:2023-11-30 发布日期:2024-03-03
通讯作者: 杨永峰,Email:yyf1997@163.com
基金资助:
江苏省卫健委重点科研项目(ZD2021061);江苏省省中医药科技发展计划项目(YB2020037);南京中医药大学自然科学基金项目(XZR2020071)

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

WANG Shuang-shuang¹, XIONG Qing-fang², HU Yi-fan², CHEN Miao-yang², YANG Yong-feng³

1. School of Public Health,Nanjing Medical University, Jiangsu 211166, China;
2. Department of Hepatology, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Nanjing Second Hospital), Jiangsu 210003, China;
3. Department of Hepatology, Teaching Hospital of School of Public Health, Nanjing Medical University (Nanjing Second Hospital), Jiangsu 210003, China

Received:2023-06-30 Online:2023-11-30 Published:2024-03-03
Contact: YANG Yong-feng, Email: yyf1997@163.com

摘要/Abstract

摘要： 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。

关键词: 药物性肝损伤, 临床分型, 病理分型, 相关性

Abstract: 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.

Key words: Drug induced liver injury, Clinical classification, Pathological classification, Correlation

王双双, 熊清芳, 胡一帆, 陈妙洋, 杨永峰. 药物性肝损伤的临床与病理特点分析[J]. 肝脏, 2023, 28(11): 1280-1284.

WANG Shuang-shuang, XIONG Qing-fang, HU Yi-fan, CHEN Miao-yang, YANG Yong-feng. An analysis of clinical and pathological features of 148 cases of drug-induced liver injury[J]. Chinese Hepatolgy, 2023, 28(11): 1280-1284.

参考文献

[1] Björnsson ES, Bergmann OM, Björnsson HK, et al. Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland[J]. Gastroenterology, 2013,144(7):1419-1425.
[2] Fontana RJ. Pathogenesis of idiosyncratic drug-induced liver injury and clinical perspectives[J]. Gastroenterology,2014,146(4):914-928.
[3] Miguel A, Azevedo LF, Pereira AC, et al. Frequency of adverse drug reactions in hospitalized patients: a systematic review and meta-analysis[J]. Pharmacoepidemiol Drug Saf,2012,21(11):1139-1154.
[4] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志,2015,31(11) :1752-1769.
[5] 杨永峰. 药物性肝损伤病理学的特征及鉴别诊断[J]. 临床肝胆病杂志,2021,37(11):2530-2534.
[6] European Association for the Study of the Liver. EASL clinical practice guidelines: drug-induced liver injury[J]. J Hepatol, 2019,70(6):1222-1261.
[7] Cho J, Kim L, Li ZX, et al. Sex bias in experimental immune-mediated, drug-induced liver injury in BALB/cmice: suggested roles for Tregs, estrogen, and IL-6[J]. PLoS One,2013,8(4):e61186.
[8] Wang CY, Deng Y, Li P, et al. Prediction of biochemical nonresolution in patients with chronic drug-induced liver injury: A large multicenter study[J]. Hepatology, 2022,75(6):1373-1385.
[9] Rathi C, Pipaliya N, Patel R, et al. Drug induced liver Injury at a tertiary hospital in India: etiology, clinical features and predictors of mortality[J]. Ann Hepatol,2017,16(3):442-450.
[10] Chalasani N, Björnsson E. Risk factors for idiosyncratic drug-induced liver injury[J]. Gastroenterology, 2010,138(7):2246-2259.
[11] Stine JG, Lewis JH. Drug-induced liver injury: a summary of recent advances[J]. Expert Opin Drug Metab Toxicol,2011,7(7):875-890.
[12] Hassan A, Fontana RJ. The diagnosis and management of idiosyncratic drug-induced liver injury[J]. LiverInt,2019,39(1):31-41.
[13] Shen T, Liu YX, Shang J, et al. Incidence and etiology of drug-induced liver injury in Mainland China[J]. Gastroenterology,2019,156(8):2230-2241.
[14] 赵娇, 肖丽. 170例药物性肝损伤患者临床特征分析[J]. 肝脏,2022,27 (6):683-687.
[15] 范颖, 赵红, 谢雯. 中国首部《药物性肝损伤防治指南》解读[J]. 中华全科医师杂志,2016,15(6):416-420.
[16] 朱春雾, 王海南, 袁继丽, 等. 445例药物性肝损伤的临床分析[J]. 临床肝胆病杂志, 2018,34(2):354-358.
[17] Chalasani N, Bonkovsky HL, Fontana R, et al. Features and outcomes of 899 patients with drug- induced liver injury: the DILIN prospective study[J]. Gastroenterology,2015,148(7) :1340-1352.
[18] Kaplowitz N. Idiosyncratic drug hepatotoxicity[J]. Nat Rev Drug Discov,2005,4(6):489-499.
[19] Robles-Diaz M, Lucena MI, Kaplowitz N, et al. Use of Hy’s law and a new composite algorithm to predict acute liver failure in patients with drug- induced liver injury[J]. Gastroenterology,2014,147(1):109-118.
[20] Kleiner DE. The histopathological evaluation of drug-induced liver injury [J]. Histopathology. 2017,70(1):81-93.
[21] Ashby K, Zhuang W, González-Jimenez A, et al. Elevated bilirubin, alkaline phosphatase at onset, and drug metabolism are associated with prolonged recovery from DILI[J]. J Hepatol, 2021,75(2):333-341.
[22] 郭立杰,王超,伍彦辉,等. 药物性肝损伤不同时间临床分型与病理损伤分型关联性分析[J]. 临床误诊误治, 2020,33(4):40-45.
[23] 叶立红, 王翀奎, 邵晨, 等. 胆管细胞损伤型药物性肝损伤病理与临床生化特征分析[J]. 临床肝胆病杂志, 2020,36(5):1059-1054.