单纯淤胆型药物性肝损伤临床生化及病理特点分析

肝脏 ›› 2024, Vol. 29 ›› Issue (1): 37-40.

单纯淤胆型药物性肝损伤临床生化及病理特点分析

白欢欢, 冯惠君, 郭立杰, 张海丛, 何晓燕, 孟爽, 张向娥

050021 河北石家庄市第五医院(白欢欢,郭立杰,张海丛,张向娥);050000 河北省胸科医院(冯惠君);050056 石家庄市第二医院(何晓燕,孟爽)

收稿日期:2023-04-28 出版日期:2024-01-31 发布日期:2024-03-01
通讯作者: 张向娥,Email:346912846@qq.com
基金资助:
河北省医学科学研究课题计划项目(20171001)

An analysis on the clinical biochemical and pathological characteristics of simple cholestatic type of drug induced liver injury

BAI Huan-huan¹, FENG Hui-jun², GUO Li-jie³, ZHANG Hai-cong³, HE Xiao-yan³, MENG Shuang³, ZHANG Xiang-e¹

1. The Fifth Hospital of Shijiazhuang, Hebei 050021, China;
2. Hebei Chest Hospital, Shijiazhuang 050000, China;
3. The Second Hospital of Shijiazhuang, Hebei 050056, China

Received:2023-04-28 Online:2024-01-31 Published:2024-03-01
Contact: ZHANG Xiang-e,Email:346912846@qq.com

摘要/Abstract

摘要： 目的探讨单纯淤胆型药物性肝损伤(DILI)患者的临床特征、预后转归及病理特点。方法收集石家庄市第五医院2010年1月至2021年10月收治的38例单纯淤胆型DILI患者的临床资料,包括用药种类、病程、肝生化指标及变化趋势及病理形态特点,分析不同病理形态特点与病程及肝生化指标之间的相关性。结果 40岁以下年龄段以男性患者更多见,但40岁以上女性患者更多见。在引起单纯淤胆型DILI的药物种类中,以中药及中成药类最多见(36.8%),其次为抗生素类(13.2%)及解热镇痛类药物(13.2%)。R值绝大多数＜2(均值为1.5)。肝生化指标达峰及恢复时间具有不同变化特点;毛细胆管淤胆评分与TBil值呈中等强度相关性(r=0.545,P=0.016);小胆管变性评分与GGT峰值呈中等强度相关(r=0.538,P=0.021);其他病理形态学评分与肝生化指标峰值之间无相关性(P>0.05);病程与毛细胆管淤胆及肝细胞淤胆呈正相关(r=0.528,P=0.024;r=0.500,P=0.041);TBil达峰时间与毛细胆管淤胆呈正相关(r=0.672,P=0.002);GGT恢复正常时间与小胆管变性呈正相关(r=0.551,P=0.018);其他病理形态学评分与肝生化指标达峰及恢复时间均无相关性(P>0.05)。结论单纯淤胆型DILI具有其独特的临床、病理、肝生化学变化特点及病程演变。

关键词: 单纯淤胆型, 药物性肝损伤, 临床特征, 肝生化特点, 病理特点

Abstract: Objective To analyze the clinical, serum biochemistry and histopathological characteristics of patients with simple cholestatic type of drug induced liver injury (DILI). Methods Thirty-eight patients were diagnosed as simple cholestatic type of DILI with Liver biopsy. The causative drugs, disease course, R value for DILI classification, peak value and changing trend of liver biochemical indexes and histopathology were collected. The correlation between different pathological characteristics and the disease course and liver biochemical indexes were analyzed. Results Simple cholestatic type of DILI was more common in male patients <40 years old, but more common in female patients >40 years old. The most common drugs causing simple cholestatic type of DILI were Chinese herbs (36.8%), the next were antibiotics (13.2%) and antipyretic analgesic drugs (13.2%). Most R values are <2 (mean=1.5). The peak and recovery time of liver biochemical indexes have different characteristics. There was a moderate correlation between the score of canalicular cholestasis and TBil value (r=0.545, P=0.016). The scores of small bile duct degeneration was moderately correlated with the peak value of γ-glutamyl transpeptidase (GGT) (r=0.538, P=0.021).There was no correlation between other pathologic scores and the peak value of liver biochemical indexes (P>0.05).The course of disease was positively correlated with cholestasis in canalicular and hepatocyte (r=0.528, P=0.024; r=0.500, P=0.041). Peak time of TBil was positively correlated with canalicular cholestasis (r=0.672, P=0.002). The normal time of GGT was positively correlated with the degeneration of small bile duct (r=0.551, P=0.018). There was no correlation between other pathologic scores and the peak and recovery time of liver biochemical indexes (P>0.05). Conclusion Simple cholestatic type of DILI has its unique clinical, pathological and hepatic biochemical characteristics and disease evolution course.

Key words: Simple cholestasis, Drug induced liver injury, Clinical features, Characteristics of liver biochemistry, pathological features

白欢欢, 冯惠君, 郭立杰, 张海丛, 何晓燕, 孟爽, 张向娥. 单纯淤胆型药物性肝损伤临床生化及病理特点分析[J]. 肝脏, 2024, 29(1): 37-40.

BAI Huan-huan, FENG Hui-jun, GUO Li-jie, ZHANG Hai-cong, HE Xiao-yan, MENG Shuang, ZHANG Xiang-e. An analysis on the clinical biochemical and pathological characteristics of simple cholestatic type of drug induced liver injury[J]. Chinese Hepatolgy, 2024, 29(1): 37-40.

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