基于肝脏超声血流动力学和肝生化指标建立自身免疫性肝炎和药物性肝损伤的鉴别模型

肝脏 ›› 2025, Vol. 30 ›› Issue (9): 1267-1271.

基于肝脏超声血流动力学和肝生化指标建立自身免疫性肝炎和药物性肝损伤的鉴别模型

刘小方, 柯建梅

436000 鄂州鄂州市中医医院超声科(刘小方);435000 黄石黄石市中心医院(湖北理工学院附属医院)超声科(柯建梅)

收稿日期:2024-05-23 出版日期:2025-09-30 发布日期:2025-11-05
通讯作者: 柯建梅,Email:Kjm_2024110@163.com
基金资助:
湖北省自然科学基金资助项目(2021CFB331)

Development of a differentiation model for autoimmune hepatitis and drug-induced liver injury based on hepatic ultrasound hemodynamics and liver biochemical indicators

LIU Xiao-fang¹, KE Jian-mei²

1. Department of Ultrasound,Ezhou Traditional Chinese Medicine Hospital, Ezhou 436000, China;
2. Department of Ultrasound,Huangshi Central Hospital (Affiliated Hospital of Hubei University of Technology), Huangshi 435000, China

Received:2024-05-23 Online:2025-09-30 Published:2025-11-05
Contact: KE Jian-mei,Email:Kjm_2024110@163.com

摘要/Abstract

摘要： 目的基于肝脏超声血流动力学和肝生化指标建立药物诱导性自身免疫性肝炎(DIAIH)和药物性肝损伤(DILI)的鉴别模型。方法回顾性分析医院2020年1月至2023年1月收治的82例DILI患者、74例DIAIH患者的病历资料。分析DILI组与DIAIH组患者的肝脏超声血流动力学和肝生化指标差异,筛选DIAIH发病的影响因素,构建DILI与DIAIH的鉴别模型。结果 DILI组患者的门静脉血流速度快于DIAIH组,肝动脉血流速度及阻力指数低于DIAIH组,分别为:[DILI组:(22.31±3.19)cm/s、(40.23±6.47)cm/s、(0.71±0.13)cm/s,DIAIH组:(19.49±3.02)cm/s、(46.91±7.15)cm/s、(0.79±0.12)cm/s](P<0.05)。DILI组患者的总胆红素、总胆汁酸、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(GGT)、球蛋白水平均低于DIAIH组,分别为:[DILI组:(18.62)μmol/L、(7.56)μmol/L、(96.05)U/L、(206.53)U/L、(112.35)U/L、(29.13)g/L,DIAIH组:(26.01)μmol/L、(22.61)μmol/L、(129.52)U/L、(328.65)U/L、(199.34)U/L、(35.02)g/L](P<0.05)。门静脉血流速度、肝动脉血流速度、阻力指数、总胆红素、总胆汁酸、ALT是发生DIAIH的影响因素(P<0.05)。列线图模型鉴别DIAIH的灵敏度为0.825(95%CI:0.741~0.952),特异度为0.798(95%CI:0.703~0.883),ROC曲线下面积为0.827(95%CI:0.749~0.964)。结论 DILI与DIAIH患者的肝脏超声血流动力学和肝生化指标存在差异,构建基于肝脏超声血流动力学和肝生化指标的鉴别模型可用于辅助诊断鉴别DILI与DIAIH。

关键词: 药物性肝损伤, 药物诱导性自身免疫性肝炎, 超声血流动力学, 生化指标, 鉴别模型

Abstract: Objective To distinguish between DIAIH and DILI, a differential diagnosis model for drug-induced autoimmune hepatitis (DIAIH) and drug-induced liver injury (DILI) was established based on hepatic ultrasound hemodynamics and liver biochemical indicators. Methods A retrospective analysis was conducted on medical records of 82 cases of drug-induced liver injury (DILI) and 74 cases of drug-induced autoimmune hepatitis (DIAIH) admitted to the hospital from January 2020 to January 2023. The study aimed to analyze the differences in hepatic ultrasound hemodynamics and liver biochemical indicators between the DILI and DIAIH groups, identify factors influencing the onset of DIAIH, and establish a differentiation model for DILI and DIAIH. Results The portal vein blood flow velocity in DILI group was higher than that in DIAIH group, and the hepatic artery blood flow velocity and resistance index were lower than that in DIAIH group [DILI group: (22.31±3.19) cm/s, (40.23±6.47) cm/s, (0.71±0.13) cm/s, DIAIH group: (19.49±3.02) cm/s (46.91±7.15) cm/s, (0.79±0.12) cm/s] (P<0.05). The levels of total bilirubin, total bile acid, alkaline phosphatase (ALP), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) and globulin in DILI group were lower than those in DIAIH group [DILI group (18.62) μmol/L, (7.56) μmol/L, (96.05) U/L, (206). 53) U/L, (112.35) U/L, (29.13) g/L, DIAIH group (26.01) μmol/L, (22.61) μmol/L, (129.52) U/L, (328.65) U/L, (199.34) U/L, (35.02) g/L, ] (P<0.05). Portal vein blood flow velocity, hepatic artery blood flow velocity, resistance index, total bilirubin, total bile acids, and ALT were identified as influencing factors for the occurrence of DIAIH (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that the sensitivity of the column chart model in distinguishing DIAIH was 0.825 (95%CI: 0.741~0.952), the specificity was 0.798 (95%CI: 0.703~0.883), and the area under the curve was 0.827 (95%CI: 0.749~0.964). Conclusion There are differences in hepatic ultrasound hemodynamics and liver biochemical indicators between DILI and DIAIH patients. Constructing a differentiation model based on hepatic ultrasound hemodynamics and liver biochemical indicators could be used to assist in the diagnostic differentiation of DILI and DIAIH.

Key words: Drug-induced liver injury, Drug-induced autoimmune hepatitis, Ultrasound hemodynamics, Biochemical indicators, Differentiation model

刘小方, 柯建梅. 基于肝脏超声血流动力学和肝生化指标建立自身免疫性肝炎和药物性肝损伤的鉴别模型[J]. 肝脏, 2025, 30(9): 1267-1271.

LIU Xiao-fang, KE Jian-mei. Development of a differentiation model for autoimmune hepatitis and drug-induced liver injury based on hepatic ultrasound hemodynamics and liver biochemical indicators[J]. Chinese Hepatolgy, 2025, 30(9): 1267-1271.

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