血清总胆汁酸对伴胆汁淤积的药物性肝损伤的诊断价值  

Diagnostic value of serum total bile acid in drug-induced cholestasis

作　　者：许姗姗[1] 宋静静[1] 仇丽霞[1] 张晶[1] XU Shan-shan;SONG Jing-jing;QIU Li-xia;ZHANG Jing(Third Department of Liver Disease Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肝病中心三科,北京100069

出　　处：《肝脏》2023年第2期218-221,228,共5页Chinese Hepatology

基　　金：佑安肝病艾滋病基金科研课题(YNKTTS20180115);激素治疗重症药物性肝损伤前瞻性随机对照研究(ChiCTR1900021738)。

摘　　要：目的 探讨血清总胆汁酸(TBA)对伴胆汁淤积药物性肝损伤的诊断价值。方法 收集2013年7月—2019年8月于首都医科大学附属北京佑安医院住院的药物性肝损伤(DILI)患者的临床资料、病理资料。以病理表现为依据,将入组患者分为伴胆汁淤积和无胆汁淤积两组,比较两组患者TBA水平。结果 共入组281例DILI患者,无胆汁淤积组患者127例(45.20%),胆汁淤积组患者154例(54.80%),其中胆汁淤积患者胆汁淤积病理表现以肝细胞胆汁淤积为主(61.04%)。两组患者性别、年龄、临床症状均无显著差异。胆汁淤积组患者TBA、总胆红素(TBil)及直接胆红素(DBil)均显著高于无胆汁淤积组患者[(97.01±72.08) vs (71.84±72.64)μmol/L、(139.17±147.23) vs (86.77±90.16)μmol/L、(102.30±110.63) vs (59.70±68.64)μmol/L,P均<0.05],且住院时间更长(P<0.05)。单因素分析表明,伴胆汁淤积组患者TBA、TBil及DBil显著高于无胆汁淤积的患者。多因素分析显示,TBA是药物性肝损伤患者胆汁淤积的独立预测指标。以99.70μmol/L为临界值,TBA预测肝组织学胆汁淤积的曲线下面积(AUC)为0.603(0.536~0.671)(P=0.003),其敏感度和特异度分别为52.6%和74.0%。且当TBA≥20.1μmol/L,即可考虑患者有75%的概率存在胆汁淤积,其敏感度大于76.6%。结论 血清TBA、TBil及DBil是鉴别药物性肝损伤胆汁淤积的敏感指标;血清TBA对伴胆汁淤积的药物性肝损伤具有一定的诊断价值。Objective To investigate the diagnostic value of serum total bile acid(TBA) in drug-induced cholestasis(DRIC). Methods Clinical and pathological data of patients with drug-induced liver injury who were hospitalized in Beijing You ’an Hospital, Capital Medical University from July 2013 to August 2019 were collected. Based on pathological manifestations, the enrolled patients were grouped as having cholestasis or no cholestasis, and the TBA levels of the two groups were compared. Results A total of 281 DILI patients were enrolled, including 127(45.20%) in the non-cholestatic group(group A) and 154(54.80%) in the cholestatic group(group B). Hepatocellular cholestasis(61.04%) was the main pathological manifestation of cholestasis according to the pathological changes. There were no significant differences in gender, age and clinical symptoms between the two groups. The serum TBA, TBil and DBil levels in group B were significantly higher compared to group A(all P<0.05), and the hospital stay was longer(P<0.05). Univariate analysis showed that the serum TBA, TBil and DBil levels in group B were significantly higher than those in group A. Multivariate analysis showed that TBA was an independent predictor of cholestasis in patients with DILI. With 99.70 μmol/L as the critical value, the area under curve(AUC) of TBA for predicting hepatic histological cholestasis was 0.603(0.536-0.671)(P=0.003), and its sensitivity and specificity were 52.6% and 74.0%, respectively. When the serum TBA level≥20.1 μmol/L, the probability of cholestasis could be considered as 75%, and the sensitivity was greater than 76.6%. Conclusion Serum TBA, TBil and DBil are sensitive indexes for DRIC. Moreover, serum TBA can be diagnostically useful.

关 键 词：药物性肝损伤 胆汁淤积 胆汁酸 病理 

分 类 号：R575[医药卫生—消化系统]