摘要
目的分析和比较三种药物性肝损害常见的诊断标准的差异性和准确性,以验证其临床实用价值。方法采用回顾性研究的方法,对以"药物性肝损害"为第一诊断的119例患者按国际药物性肝损害分型标准进行临床分型,分析总结其致病药物种类,并运用ICM标准(RUCAM/CIOMS/Danan)、Maria标准、我国常用标准等诊断评分系统对其进行重新诊断,以比较不同诊断方法的差异性。结果 119例患者中肝细胞型共71例,占59.7%,胆汁淤积型28例,占23.5%,混合型20例,占16.8%。致病药物种类依次为:中药、抗结核类药物、抗生素、降脂类药物、保健品、解热镇痛类药、降压药、免疫抑制剂、他巴唑、肿瘤化疗类药物、降糖药物、胃药、藏药。在119例患者中,ICM标准的五项量化评分等级中,非常可能、很可能及可能三个评分等级累计共有115例(95.8%)。我国常用标准中,有77例(64.7%)被纳入考虑范围。而Maria标准的五项评分等级中,无一例患者确诊为药物性肝损害。可能性大及有可能的两个评分等级累计仅14例(11.8%)。结论 ICM标准对于药物性肝损害诊断符合率最高;我国常用标准对于亚洲人群诊断符合率尚可,应用简便,可操作性强;Maria标准与临床诊断符合率相对较低。
Objective To analyze and compare the accuracy and difference of three common diagnostic standards of drug-induced liver injury so as to verify the clinical value. Methods With the method of retrospective study, 119 cases diagnosed as drug-induced liver injury firstly in Changhai hospital were classified based on international drug-induced liver injury classification standard.The drugs which induced liver injuries were analyzed and summarized.ICM international consensus standard, Maria′s diagnostic scale and Chinese common standard were employed to diagnose the 119 cases again and then the differences of diagnostic results were analyzed and compared. Results According to the liver function change and symptom, 119 cases were divided into three types： 71 cases of hepatocellular damage type（59.7%）, 28 cases of cholestatic damage type（23.5%）and 20 cases of mixed damage type（16.8%）.The kinds of drugs induced liver injuries in the 119 patients were as following：traditional Chinese medicine,antituberculosis medicines,antibiotics, lipid lowering agents, over-the-counter health stuff, antipyretic analgesic, antihypertensive, immunosuppressive agents, methimazole, chemotherapy medicines, hypoglycemic drugs, stomach medicines, Tibetan medicines. Among the 119 cases, according to ICM standard, 115 cases（95.8%） were classified as ＂probable, likely and possible＂.According to Chinese standard,77 cases（64.7%） could be taken into account.However,according to Maria′s diagnostic scale,no case was definitely. diagnosed as drug-induced liver injury with only 14 cases（11.8%） were classified as ＂probable and likely＂. Conclusion The accordance rate of ICM standard for drug-induced liver injury is the highest. The diagnosis of coincidence rate in Chinese common standard for Asian populations is high,and convenient for application,and operable, but there was few research on foreign groups. The diagnosis of coincidence rate in the classification of Maria′s diagnostic scale is poor relatively.
出处
《肝脏》
2012年第1期17-20,共4页
Chinese Hepatology
关键词
药物性肝损害
诊断
分析与比较
Drug-induced liver injury
Diagnosis
analysis and comparison
