药物相关性胆管消失综合征患者胆红素水平与预后的相关性  

Correlation between elevated bilirubin and prognosis in patients with drug-induced vanishing bile duct syndrome

作　　者：孟爽[1] 冯惠君 张海丛[3] 郭立杰[3] 何晓燕 白欢欢 张向娥 叶立红[3] MENG Shuang;FENG Hui-jun;ZHANG Hai-cong;ZHANG Xiang-e(Endocrinology Department,The Second Hospital of Shijiazhuang(Jiazhuang Hebei,050056),China;不详)

机构地区：[1]石家庄市第二医院内分泌科,河北石家庄050056 [2]河北省胸科医院 [3]石家庄市第五医院

出　　处：《中西医结合肝病杂志》2024年第6期513-516,520,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：河北省医学科学研究课题计划项目(No.20171001)。

摘　　要：目的:观察药物相关性胆管消失综合征(D-VBDS)患者胆红素升高与否与病理形态特点及预后转归之间的相关性。方法:回顾性分析经肝穿刺组织病理检查明确诊断为D-VBDS的患者45例,根据病程中是否出现胆红素升高分为胆红素正常组和高胆红素组,观察两组患者的临床资料、用药史、生化指标、病理形态学特点及预后情况等数据,并对比分析两组患者胆红素升高与否与病理形态特点及预后之间的相关性。结果:胆红素正常组和高胆红素组患者在平均发病年龄、性别构成及病程等方面差异均无统计学意义(P>0.05),中药或中成药用药在两组均占比最高(39.3%vs 40.0%)。除皮肤巩膜黄染外,两组患者其他症状及体征差异均无统计学意义(P>0.05);高胆红素组TBil、DBil、ALP、GGT、TBA及CHOL明显高于胆红素正常组(P<0.05);高胆红素组患者胆色素沉积、毛细胆管胆栓、泡沫样细胞评分均高于胆红素正常组,其他病理形态评分差异均无统计学意义(P>0.05)。细胆管增生、汇管区炎症、纤维化、慢性胆盐淤积是与预后相关的病理形态改变,两组患者预后情况差异无统计学意义(P>0.05)。结论:病程中是否出现胆红素升高不是影响D-VBDS患者预后的主要因素。Objective:To observe the correlation between the elevation of bilirubin in the course of the disease and the pathological characteristics and prognosis of the patients with drug-induced vanishing bile duct syndrome(D-VBDS).Methods:Forty-five patients with D-VBDS diagnosed by liver biopsy were retrospectively observed.According to whether they had elevated bilirubin during the course of the disease,they were divided into two groups.The clinical data,medication history,liver biochemical indicators,pathological morphological characteristics and prognosis of the two groups were observed,and the correlation between elevated bilirubin and pathological morphological characteristics and prognosis of the two groups were compared and analyzed.Results:There was no significant difference in the average age of onset,gender composition and course of disease between the normal bilirubin group and the high bilirubin group(P>0.05).Chinese medicine or Chinese patent medicine accounted for the highest proportion in the two groups(39.3%v 40.0%).There were no statistically significant differences in other symptoms and signs between the two groups except for the yellow skin and scleral staining(P>0.05).The TBil,DBil,ALP,GGT,TBA and CHOL in the high bilirubin group were significantly higher than those in the normal bilirubin group(P<0.05).The scores of bile pigment deposition,bile thrombosis of bile capillaries and foam-like cells in the hyperbilirubinemia group were higher than those in the normal bilirubin group,and there was no significant difference in other pathological morphology scores(P>0.05).Bile duct hyperplasia,portal inflammation,fibrosis,and chronic cholestasis are the pathological morphological changes related to the prognosis.There was no statistically significant difference in the prognosis of the two groups(P>0.05).Conclusion:Elevated bilirubin is not the main factor affecting the prognosis of patients with D-VBDS.

关 键 词：胆管消失综合征 药物相关性 胆红素 预后 病理特点 

分 类 号：R575.7[医药卫生—消化系统]