430例药物性肝损伤的临床特征及生化指标分析  

Analysis of Clinical Characteristics and Biochemical Indexes of 430 Cases of Drug-induced Liver Injury

作　　者：韩雪 李月 杨慧 HAN Xue;LI Yue;YANG Hui(Department of Clinical Laboratory,Changzhou Third People's Hospital,Changzhou Jiangsu 213001,China;Laboratory of Microbiology,Changchun Center for Disease Control and Prevention,Changchun Jilin 130000,China)

机构地区：[1]常州市第三人民医院检验科,江苏常州213001 [2]长春市疾病预防控制中心微生物检验所,吉林长春130000

出　　处：《中国卫生标准管理》2022年第21期127-131,共5页China Health Standard Management

摘　　要：目的对430例药物性肝损伤患者的临床特征及生化指标进行分析。方法收集2019年1月—2021年12月在常州市第三人民医院收治的药物性肝损伤(drug-induced liver injury,DILI)病例,共430例,采集患者的性别、年龄、身体质量指数(body mass index,BMI)、用药类型等一般资料进行统计分析。记录患者的生化指标丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、碱性磷酸酶(alkaline phosphatase,ALP)、γ-谷氨酰基转移酶(γ-glutamyltransferase,γ-GT或GGT)、总胆红素(total bilirubin,TBIL)、总胆汁酸(total bile acid,TBA)、甘胆酸(glycocholic acid,CG),对以上数据进行统计学分析。结果共收集因药物性肝损伤住院病例430例,其中男性148例(34.4%),女性282例(65.6%),年龄11~83岁。按致DILI药物类别分组,分别为中药组187例(43.5%)、西药组80例(18.6%)、化疗用药组93例(21.6%)、抗痨用药组57例(13.3%)、中西结合用药组13例(3.0%)。各组肝细胞损伤型例数分别为104例、21例、26例、26例、4例,胆汁淤积型例数分别为37例、31例、36例、16例、5例,(χ2=32.395,P<0.05)。各组生化指标中位数:ALT分别为:330.0、154.5、130.2、156.7、234.9 U/L(H=38.437,P<0.05)。A S T分别为:134.0、74.0、81.0、111.0、61.0 U/L(H=20.328,P<0.05)。ALP分别为:141.5、115.5、115.0、85.0、117.0 U/L(H=40.712,P<0.05)。GGT分别为:155.2、142.7、141.1、96.0、123.0 U/L(H=19.277,P<0.001)。TBIL分别为:22.1、14.9、11.3、11.1、12.7 mol/L(H=73.603,P<0.05)。T B A分别为:12.5、6.4、4.8、7.4、4.4 mol/L(H=28.097,P<0.05)。C G分别为:3.5、1.81.6、2.1、2.8 mg/L(H=26.331,P<0.05)。结论本研究药物性肝损伤致病原因以中药为主。中药和抗痨用药肝损伤类型以肝细胞损伤型为主,西药、化疗用药及中西结合用药肝损伤类型以胆汁淤积型为主。不同致病原因生化指标之间有统计学差异,其中中药致肝损害各生化指标�Objective To analyze the clinical characteristics and biochemical indices of 430 patients with drug-induced liver injury.Methods A total of 430 patients with drug-induced liver injury(DILI)admitted to Changzhou Third People's Hospital from January 2019 to December 2021 were collected for statistical analysis,including gender,age,body mass index(BMI),medication type,and other general information.Biochemical indexes alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(γ-GT or GGT),total bilirubin(TBIL),total bile acid(TBA)and glycocholic acid(CG)of the patients were recorded.Statistical analysis was made on the above data.Results A total of 430 hospitalized patients with drug-induced liver injury were collected,including 148 males(34.4%)and 282 females(65.6%),aged 11~83 years old.According to the category of DILI-causing drugs,187 cases(43.5%)were divided into traditional Chinese medicine(TCM)group,80 cases(18.6%)in western medicine group,93 patients(21.6%)in chemotherapy group,57 cases(13.3%)in antituberculosis group,13 patients(3.0%)were treated with Chinese and Western medicine.There were 104,21,26,26 and 4 cases of hepatocellular injury in each group,and 37,31,36,16 and 5 cases of cholestasis in each group,respectively(χ2=32.395,P<0.05).Median biochemical indexes of each group:ALT:330.0,154.5,130.2,156.7 and 234.9 U/L,respectively(H=38.437,P<0.05).AST:134.0,74.0,81.0,111.0,61.0 U/L(H=20.328,P<0.05).ALP:141.5,115.5 and 115.0,85.0117.0 U/L(H=40.712,P<0.05).GGT:155.2,142.7,141.1,96.0,123.0 U/L(H=19.277,P<0.001).TBIL:22.1,14.9,11.3,11.1 and 12.7 mol/L(H=73.603,P<0.05).TBA:12.5,6.4,4.8,7.4,4.4 mol/L(H=28.097,P<0.05).CG:3.5,1.8,1.6,2.1,2.8mg/L(H=26.331,P<0.05).Conclusion Chinese medicine is the main cause of drug-induced liver injury in this study.The type of liver injury in traditional Chinese medicine and anti-tuberculosis drugs are mainly liver cell injury,while the type of liver injury in western medicine,chemotherapy drugs and combination of Chinese and

关 键 词：药物性肝损伤 中药 西药 化疗用药 抗痨用药 生化指标 

分 类 号：R969[医药卫生—药理学]