摘要
目的旨在分析伴有自身免疫现象的药物性肝损伤（DILI）临床特点,为临床工作总结经验。方法收集北京佑安医院2011-2013年临床诊断为DILI的患者51例,分别根据抗核抗体（ANA）阳性与否（ANA阳性组和ANA阴性组）、自身免疫性肝炎（AIH）简易评分高低（1~4分为低分组,≥5分为高分组）分组,比较实验室指标[ALT、AST、TBil、白蛋白（Alb）、ALP、GGT、凝血酶原时间（PT）、Ig M、Ig A、Ig M]、住院时间、病情反复情况。正态计量资料组间比较采用t检验,非正态计量资料组间比较采用秩和检验,计数资料组间比较采用χ2检验。结果 51例患者中,ANA阳性34例,ANA阴性17例;高分组17例,低分组34例。在两种分组标准中,ALT、TBil、Alb、ALP、GGT、PT、Ig M水平及住院天数方面差异均无统计学意义（P值均〉0.05）;两种分组方式中,AST及Ig G水平差异均有统计学意义（P值均〈0.05）;根据AIH简易评分方式分组,高分组与低分组比较,Ig A水平[（3.87±1.73）g/L vs（2.75±1.38）g/L]及病情反复比例（10/17 vs 8/34）方面差异均有统计学意义（P值均〈0.05）。结论单纯DILI与伴有自身免疫性现象DILI临床表现相似,AIH简易评分标准在伴有自身免疫性现象的DILI中值得借鉴应用。
Objective To analyze the clinical characteristics of drug- induced liver injury（ DILI） accompanied by autoimmune phenomena and to provide evidence for clinical practice. Methods An analysis was performed on the clinical data of 51 patients who were admitted to Beijing You＇an Hospital from 2011 to 2013 and diagnosed with DILI. The participants were divided into anti- nuclear antibody（ ANA）-positive group and ANA- negative group and,according to the simple scoring system for autoimmune hepatitis（ AIH）,divided into low-score（ sore： 1- 4） group and high- score（ score≥5） group,respectively. Comparison was made for laboratory parameters [alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,total bilirubin（ TBil）,albumin（ Alb）,alkaline phosphatase（ ALP）,gamma-glutamyl transpeptidase（ GGT）,prothrombin time（ PT）,immunoglobulin M（ Ig M）,immunoglobulin A（ Ig A）,immunoglobulin G（ Ig G） ],length of hospital stay,and recurrence. Comparison of normally distributed continuous data between groups was performed by t test,comparison of non- normally distributed continuous data between groups was made by rank- sum test,and comparison of categorical data between groups was conducted by chi- square test. Results Among the 51 patients,34 cases were positive for ANA,and 17 cases were negative for ANA; 17 cases were in the high- score group,and 34 cases were in the low- score group. There were no significant differences in ALT,TBil,Alb,ALP,GGT,PT,and Ig M between the two groups for both grouping criteria（ all P 0. 05）. AST and Ig G differed significantly between the two groups for both grouping criteria（ all P 0. 05）. The Ig G level and recurrence rate in the high- score group（ 3. 87 ± 1. 73 g / L and 10 /17） were significantly higher than those in the low- score group（ 2. 75 ± 1. 38 g / L and 8 /34）（ both P 0. 05）. Conclusion The clinical manifestations are similar between patients with DILI alone and those with DILI accompanied by autoimmune phenomena. The simple scoring system for AIH is worthy of clinical application in DILI accompanied by autoimmune phenomena.
出处
《临床肝胆病杂志》
CAS
2015年第8期1303-1306,共4页
Journal of Clinical Hepatology
关键词
药物性肝损伤
抗体
抗核
自身免疫
drug-induced liver injury
antibodies
antinuclear
autoimmunity
