药物性肝损伤与原发性胆汁性肝硬化的临床特征比较

杨俊; 于雅丽; 郑长青

doi:10.3969/j.issn.1001-5256.2016.04.024

药物性肝损伤与原发性胆汁性肝硬化的临床特征比较

DOI: 10.3969/j.issn.1001-5256.2016.04.024

1. 中国医科大学附属盛京医院第二消化内科病房
2. 郑州市第七人民医院消化科

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中图分类号: R575.22
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出版历程
- 出版日期: 2016-04-20

Clinical features of drug- induced liver injury and primary biliary cirrhosis: a comparative analysis

Second Department of Gastroenterology, Shengjing Hospital of China Medical University

摘要

摘要:
目的探讨并比较分析药物性肝损伤（DILI）与原发性胆汁性肝硬化（PBC）的临床特征。方法选取中国医科大学附属盛京医院2005年1月-2013年12月确诊的116例PBC及124例DILI患者,比较2组患者的临床特征、实验室检查指标及肝组织病理学检查结果。计量资料组间比较采用t检验或Nemenyi秩和检验,计数资料组间比较采用χ2检验。结果 2组发病年龄和性别组成差异有统计学意义（P值均<0.05）。2组血清学指标（除白蛋白）、免疫学指标Ig G、Ig M和Ig A、自身抗体阳性率（除抗平滑肌抗体）的差异均有统计学意义（P值均<0.05）。PBC组织学表现主要为肝细胞水肿样变性（30例）,胆管周围炎性细胞浸润（29例）,小胆管不典型增生（28例）等;DILI组织学表现主要为肝细胞脂肪变性（15例）,肝细胞点状坏死脱失（14例）等。结论 DILI和PBC在实验室检查、病理学检查等方面存在差异,对临床鉴别诊断工作有一定的指导意义。
- 肝炎,中毒性 /
- 肝硬化,胆汁性 /
- 自身抗体 /
- 对比研究
Abstract:
Objective To investigate and compare the clinical features of drug- induced liver injury( DILI) and primary biliary cirrhosis( PBC). Methods A total of 116 PBC patients and 124 DILI patients who were diagnosed in Shengjing Hospital of China Medical University from January 2005 to December 2013 were enrolled,and clinical features,laboratory indices,and the results of liver biopsy were compared between the two groups. The t- test or Nemenyi rank sum test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. Results There were significant differences in age of onset and gender composition between the two groups( both P < 0. 05). The serological markers( except albumin),immunological indicators( Ig G,Ig M,and Ig A),and positive rate of autoantibodies( except SMA) showed significant differences between the two groups( all P < 0. 05). The histological appearances of PBC were hepatocyte edema( 30 patients),inflammatory cell infiltration around the bile duct( 29 patients),and atypical hyperplasia of the small bile duct( 28 patients),and those of DILI were hepatocyte steatosis( 15 patients)and spotty necrosis and loss of hepatocytes( 14 patients). Conclusion DILI and PBC are different in the aspects of laboratory tests and pathological examinations,which has a certain guiding significance in differential diagnosis in clinical practice.
- hepatitis,toxic /
- liver cirrhosis,biliary /
- autoantibodies /
- comparative study

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参考文献(24)

[1]European Association for the Study of the Liver.EASL clinical practice guidelines:management of cholestatic liver diseases[J].JHepatol,2009,51(2):237-267.

[2]DANAN G,BENICHOU C.Causality assessment of adverse reactions to drugs-I.A novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries[J].J Clin Epidemiol,1993,46(11):1323-1330.

[3]ZENG LL,ZHOU GQ.Diagnostic criteria of drug-induced liver injury and their clinical application[J].ADRJ,2011,13(1):17-20.(in Chinese)曾玲玲,周桂琴.药物性肝损害诊断标准及其临床应用[J].药物不良反应杂志,2011,13(1):17-20.

[4]ZHOU XY,TIAN YZ.The recent advances in the treatment of refractory primary biliary cirrhosis[J].Jilin J Tradit Chin Med,2014,34(11):1185-1188.(in Chinese)周新源,田耀洲.难治性原发性胆汁性肝硬化治疗进展[J].吉林中医药,2014,34(11):1185-1188.

[5]CHEN QB,PENG AP,LI CC,et al.Suppressive effects of bezafibrate on proliferation and cytokine production by CD4+T cells from patients with primary biliary cirrhosis[J].Chin J Immunol,2014,30(10):1388-1392.(in Chinese)陈曲波,彭桉平,黎翠翠,等.苯扎贝特对原发性胆汁性肝硬化患者外周血CD4+T细胞的抑制作用研究[J].中国免疫学杂志,2014,30(10):1388-1392.

[6]HU Q,LIU W,SHAO H.Research progress of pharmacotherapy drug-induced liver injury[J].Chin J Clin Pharmacol Ther,2016,21(2):231-236.(in Chinese)胡琴,刘维,邵宏.药物性肝损伤的药物治疗研究进展[J].中国临床药理学与治疗学,2016,21(2):231-236.

[7]BNICHOU C.Criteria of drug-induced liver disorders.Report of an international consensus meeting[J].J Hepatol,1990,11(2):272-276.

[8]NAVARRO V.Hepatic adverse event nomenclature document[EB/OL].(2006-11-17)[2015-09-21].http://www.fda.gov/cder/livertox/presentaions 2005/vic_Navarro.ppt.

[9]WATKINS P,SEEFF LB.Drug-induced liver injury:summary of a single topic clinical research conference[J].Hepatology,2006,43(3):618-631.

[10]SHAKIL A,KRAMER D,MAZARIEGOS G,et al.Acute liver failure:clinical features,outcome analysis,and applicability of prognostic criteria[J].Liver Transpl,2000,6(2):163-169.

[11]LINDOR KD,GERSHWIN ME,POUPON R,et al.Primary biliary cirrhosis[J].Hepatology,2009,50(1):291-308.

[12]FONTANA RJ,SEEFF LB,ANDRADE RJ,et al.Standardization of nomenclature and causality assessment in drug-induced liver injury:summary of a clinical research workshop[J].Hepatology,2010,52(2):730-742.

[13]CHALASANI N,FONTANA RJ,BONKOVSKY HL,et al.Causes,clinical features,and outcomes from a prospective study of drug induced liver injury in the United States[J].Gastroenterology,2008,135(6):1924-1934.

[14]WANG J,LIU DW,ZHAN SY.The advancement in epidemiological study of drug-induced liver disease[J].Mod Prev Med,2010,37(7):1393-1395.(in Chinese)王剑,刘殿武,詹思延.药物性肝病流行病学研究进展[J].现代预防医学,2010,37(7):1393-1395.

[15]HIRSCHFIELD GM.Diagnosis of primary biliary cirrhosis[J].Best Pract Res Clin Gastroenterol,2011,25(6):701-712.

[16]ANDRADE RJ,LUCENA MI,KAPLOWITZ N,et al.Outcome of acute idiosyncratic drug-induced liver injury:long-term follow-up in a hepatotoxity registry[J].Hepatology,2006,44(6):1581-1588.

[17]WATKINS PB,SEEFF LB.Drug-induced liver injury:summary of a single topic clinical research conference[J].Hepatology,2006,43(3):618-631.

[18]TENG GJ,ZHANG W,SUN Y,et al.Three cases of drug-induced hepatitis developing into autoimmune liver disease:a literature review[J].Chin Hepatol,2010,15(5):397-399.(in Chinese)滕光菊,张伟,孙颖,等.药物性肝炎发展为自身免疫性肝病3例文献复习[J].肝脏,2010,15(5):397-399.

[19]SOHDA T,SHIGA H,NAKANE H,et al.Rapid-onset primary biliary cirrhosis resembling drug-induced liver injury[J].Intern Med,2005,44(10):1051-1054.

[20]WANG XX,LIU YM,LIU H,et al.Clinical pathology features analysis of drug-induced liver injury in patients with autoantibodies[J].China Med Herald,2013,10(25):85-87.(in Chinese)王欣欣,刘燕敏,刘晖,等.自身抗体阳性的药物性肝损害临床病理特点分析[J].中国医药导报,2013,10(25):85-87.

[21]RAO YF,ZHENG FY,ZHANG XG.Immunological mechanisms of drug-induced liver injury(DILI)[J].Chin Pharmacol J,2008,43(16):1207-1210.(in Chinese)饶跃峰,郑飞跃,张幸国.药物性肝损伤的免疫学机制[J].中国药学杂志,2008,43(16):1207-1210.

[22]LIU YM.The clinical feature and prognosis in patients with drug induced liver injury complicated with positive autoantibodies detection[J].J Clin Hepatol,2012,28(5):335-338.(in Chinese)刘燕敏.药物性肝损害伴自身抗体阳性患者临床特征及转归[J].临床肝胆病杂志,2012,28(5):335-338.

[23]FAN LY,ZHONG RQ.Studies on pathogenesis of primary biliary cirrhosis[J].Chin J Hepatol,2002,10(5):392-394.(in Chinese)范列英,仲人前.原发性胆汁性肝硬化发病机制研究进展[J].中华肝脏病杂志,2002,10(5):392-394.

[24]DEGOTT C,FELDMANN G,LARREY D,et al.Drug-induced prolonged cholestasis in adults:a histological semiquantitative study demonstrating progressive ductopenia[J].Hepatology,1992,15(2):244-251.

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