合并慢性胆汁淤积性肝病对慢性药物性肝损害患者临床表现及对治疗应答的影响  

Features of chronic cholestatic liver disease,as a kind of drug-induced liver injury

作　　者：陈杰[1] 范作鹏[1] 梁珊[1] 聂巍[1] 仇丽霞[1] 杨海霞[1] 林伟[1] 刘义荣[1] 张晶[1] 胡中杰[1] Chen Jie FanZuopeng Liang Shan et al(Department of Hepatitis C ＆ Toxic Liver Diseases, You＇ an Hospital, Capital MedicalUniversity Beijing 100069 China)

机构地区：[1]首都医科大学附属北京佑安医院丙型肝炎与中毒性肝病科,北京市100069

出　　处：《实用肝脏病杂志》2017年第6期720-723,共4页Journal of Practical Hepatology

基　　金：北京市科技计划项目(编号:Z121107001012086);中国肝炎防治基金会天晴肝病研究基金项目(编号:TQGB20140052)

摘　　要：目的探讨慢性药物性胆汁淤积性肝病的病因、临床特点及对治疗应答的影响。方法 2011年1月~2013年12月在我院住院治疗的慢性药物性肝损伤(DILl)患者87例,其中23例呈胆汁淤积性肝病(CLD)表现,不伴有胆汁淤积症的慢性DILI患者64例,比较两组临床资料的异同。结果在23例CLD患者中,肝细胞型11例、胆汁淤积型7例、混合型5例,在64例DILI患者中,肝细胞型50例,胆汁淤积型4例,混合型10例,两组临床分型差异具有统计学意义(P<0.01);引起两组发病的药物占比无统计学差异(P>0.05);23例CLD患者血清GGT和ALP分别为【430.7(156.00,1142.00)】U/L和(285.07±131.52)U/L,显著高于64例DILI患者的【111.5(18.00,185.60)】U/L和(140.28±101.36)U/L(P<0.05);两组血清ALT、GGT、ALP和TBIL复常时间差异无统计学意义(P>0.05)。结论慢性药物性胆汁淤积性肝病患者兼具肝脏炎症和胆汁淤积的临床表现,经积极治疗后近期预后好。Objective To summarize the features of chronic cholestatic liver disease（CLD）, asa kind ofdrug-induced liver injury（DILI） . Methods 87 patients with DILI were recruited between Jan. 2011 and Dec.2013 in this study. The diagnosis was made by RUCAM score of equal to or greater than six at the base ofexclusion. Results The clinical classification presented as CLD in 23, and as DILI without intrahepatic cholestasisin 64 cases, and the cholestatic disease was found more common in CLD patients （P 〈0.01） ; the triggeringmedicines, including Chinese herbal medicines in the two groups, was not significantly different （P〉0.05） ; serumgamma-glutamyl transpeptidase（GGT）and alkaline phosphates（ALP）levels in 23 patients with CLD were【430.7（156.00, 1142.00） 】U/L and（285.07±131.52）U/L, much higher than【111.5（18.00, 185.60） 】U/L and （140.28±101.36）U/L（P〈0.05）in 64 patients with DILI; the recovering time for serum alanine aminotransferase, GGT, ALPand bilirubin back to normal in the two groups was not significantly different （P〉0.05） . Conclusions The patientswith chronic drug induced cholestatic liver disease have clinical manifestations of liver inflammation andcholestasis. They might get good prognosis in the short-term observation.

关 键 词：药物性肝损伤 胆汁淤积性肝病 临床特点 预后 

分 类 号：R575[医药卫生—消化系统]