不同病理分型慢性药物性肝损伤患者临床及血清学特征对比研究

摘要/Abstract

摘要： 目的对比分析不同病理分型慢性药物性肝损伤患者临床及血清学特点及差异。方法回顾性观察石家庄市第五医院86例经肝穿组织病理检查,明确诊断为慢性药物性肝损伤(DILI)患者的临床及血清学资料,根据病理损伤靶点的不同将其分为慢性肝炎组及慢性淤胆组,对比分析两组患者的一般资料、用药史、过敏史、用药时长、临床严重程度分级、合并基础疾病情况、反复发作次数,以及病程中历次血清学指标等资料。结果两组均以45岁及以上的中老年女性患者更多见,两组性别构成比及平均年龄比较差异均无统计学意义(P>0.05),但慢性肝炎组的反复发作次数多于慢性淤胆组(P<0.05);两组临床严重程度分级比较差异有统计学意义(P<0.05);平均病程在两组间比较差异无统计学意义(P>0.05)。两组最常见用药均为中药或中成药,共44例(51.2%),联合用药45例(52.3%),单一用药27例(31.4%),有化学接触史14例(16.3%),详细用药占比在两组间比较差异无统计学意义(P>0.05)。两组患者合并症占比前三位均为高血压、糖尿病及高脂血症;16例有过敏史(18.6%)。慢性淤胆组血清ALP、GGT、TC、PA、HDL、LDL高于慢性肝炎组(P<0.05);慢性肝炎组淋巴细胞比率(LY%)水平高于慢性淤胆组(P<0.05)。两组患者最常见的自身抗体均为抗核抗体,共36例(41.9%)(P>0.05),慢性淤胆组的抗线粒体抗体明显多于慢性肝炎组(P<0.05),其他自身抗体指标在两组间比较差异无统计学意义(P>0.05)。结论不同病理分型慢性DILI患者具有不同的临床及血清学特征,明确不同病理分型患者的临床特征差异,对临床医生深入认识慢性DILI具有重要意义。

关键词: 慢性, 药物性肝损伤, 肝炎型, 淤胆型, 临床特征, 血清学

Abstract: Objective To compare and analyze the clinical and serological characteristics and differences of patients with different pathological types of chronic drug-induced liver injury (DILI). Methods 86 patients with chronic DILI by histopathology were retrospectively observed at the Fifth Hospital of Shijiazhuang. Patients were divided into chronic lobular hepatitis group and chronic cholestasis group according to different pathological injury targets. The general data, medication history, allergy history, course of disease, clinical severity grading, combined with other underlying diseases, recurrent attacks, and previous serological indicators during the course of the disease were compared between the two groups. Results Middle-aged and elderly female patients aged 45 years and above were more common in both groups, and there was no statistical difference in gender composition ratio and average age between the two groups (P>0.05). The number of recurrent episodes in chronic hepatitis group was higher than that in chronic cholestasis group (P<0.05). Overall, there was significant difference in clinical severity between the two groups (P<0.05). There was no significant difference in the mean course of disease between the two groups (P>0.05). The most common drugs used in the two groups were traditional Chinese medicine or proprietary Chinese medicine with a total of 44 cases (51.2%). There were 45 cases (52.3%) of combined drug use, 27 cases (31.4%) of single drug use, and 14 cases (16.3%) of chemical contact history. There was no significant difference in the proportion of detailed drug use between the two groups (P>0.05). Hypertension, diabetes and hyperlipidemia accounted for the top three comorbidities in both groups. A total of 16 patients (18.6%) had allergic history in the two groups. Serum ALP, GGT, TC, PA, HDL and LDL in chronic cholestasis group were higher than those in chronic hepatitis group (P<0.05). LY% in chronic hepatitis group was higher than that in chronic cholestasis group (P<0.05). The most common autoantibody in both groups was antinuclear antibody (ANA), with 36 cases (41.9%). AMA in chronic cholestasis group was significantly higher than that in chronic hepatitis group (P<0.05). There was no significant difference in other autoantibody indexes between the two groups (P>0.05). Conclusion Patients with different pathological types of chronic DILI have different clinical and serological characteristics. It is of great significance for clinicians to understand the of patients with different pathological types in understanding chronic DILI.

Key words: Chronic, Drug-induced liver injury, Hepatitis type, Cholestatic type, Clinical features, Serology

李健, 张雅楠, 黄肖雨, 王志华, 郄兰霞, 牛宏垚. 不同病理分型慢性药物性肝损伤患者临床及血清学特征对比研究[J]. 肝脏, 2026, 31(3): 394-400.

LI Jian, ZHANG Ya-nan, HUANG Xiao-yu, WANG Zhi-hua, QIE Lan-xia, NIU Hong-yao. Comparative study on clinical and serological characteristics of patients with different pathological types of chronic drug-induced liver injury[J]. Chinese Hepatolgy, 2026, 31(3): 394-400.

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