甲基强的松龙治疗药物性肝损伤患者临床及实验室特点分析*

doi:10.3969/j.issn.1672-5069.2019.02.014

实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (2): 208-211.doi: 10.3969/j.issn.1672-5069.2019.02.014

甲基强的松龙治疗药物性肝损伤患者临床及实验室特点分析^*

黄春洋,单晶,廖慧钰,黄云丽,韩莹,张小丹,杜晓菲,任美欣,边新渠,刘燕敏

100069 北京市首都医科大学附属北京佑安医院肝病免疫科

收稿日期:2018-02-20 出版日期:2019-03-10 发布日期:2019-03-19
通讯作者: 刘燕敏,E-mail:yanmin130@sina.com
作者简介:黄春洋,男,38岁,医学硕士,主治医师。主要从事肝病研究。E-mail:ywgzz188@126.com
基金资助:
*北京市丰台区卫生系统科研项目（编号：2016-62）

Clinical and laboratory characteristics of patients with drug-induced liver injury receiving glucocorticoid therapy

Huang Chunyang, Shan Jing, Liao Huiyu, Huang Yunli, Han Ying, Zhang Xiaodan, Du Xiaofei, Ren Meixin, Bian Xinqu, Liu Yanmin

Department of Immunology and Liver Diseases,You’an Hospital,Capital Medical University,Beijing 100069,China

Received:2018-02-20 Online:2019-03-10 Published:2019-03-19

摘要/Abstract

摘要： 目的总结应用甲基强的松龙治疗药物性肝损伤（DILI）患者临床和实验室特点,为临床应用激素治疗DILI提供参考。方法 2015年3月~2016年10月诊治的DILI患者21例,在停止损肝药物和护肝治疗后,肝功能损伤加重而给予糖皮质激素治疗。应用SPSS 16.0软件进行统计学分析,对符合正态分布的计量资料应用t检验,对非正态分布的计量资料采用秩和检验,计数资料的比较采用卡方检验。结果在21例DILI患者中,男性6例,女性15例,平均年龄为（49.3±15.2）岁;急性DILI 12例,慢性DILI 9例;自身抗体阳性17例（81.0%）;15例行肝穿病理学检查,自身免疫性肝炎（AIH）简易评分为（3.9±1.2）分,未行肝穿检查患者在不计算病理学计分的AIH简易评分为（3.5±0.8）分;应用甲基强的松龙的剂量为（0.65±0.15） mg·kg^-1·d^-1,属于中小剂量;激素治疗后血生化指标好转,白细胞计数明显上升;未出现不可控制的感染;在13例随访患者,停用激素后7例出现了病情反复。结论对护肝治疗不应答的伴有自身抗体阳性的DILI患者,可选择中小剂量、中短疗程的糖皮质激素治疗,但停药后容易病情复发,值得探索停药方法。

关键词: 药物性肝损伤, 自身抗体, 糖皮质激素, 治疗

Abstract: Objective To summarize the clinical and laboratory characteristics of patients with drug-induced liver injury（DILI）. Methods 21 patients with DILI were recruited in our hospital between March 2015 and October 2016,and all the patients received methylprednisolone and 13 were followed-up for 3 to 16 months. Results Out of the 21 patients,6 were men and 15 women with an average age of（49.3±15.2） years;12 cases were diagnosed as acute DILI,and 9 as chronic;serum autoantibodies were positive in 17（81.0%） cases;liver biopsies were performed in 15 patients with DILI,and the average score of autoimmune hepatitis （AIH） was （3.9±1.2） points;serum biochemical parameters improved after glucocorticoid therapy at the dose of （0.65±0.15） mg·kg^-1·d^-1;white blood cell counts significantly increased after steroid therapy,but no complications occurred in this series;Out of 13 patients followed-up,7 relapsed after discontinuation of corticosteroids. Conclusion Glucocorticoids might be administered in patients who poorly respond to conventional therapy,especially in those with serum autoantibodies positive. But the discontinuation of steroid might lead to the relapse of illness,which needs further investigations.

Key words: Drug-induced liver injury, Antinuclear antibody, Glucocorticoid, Therapy

黄春洋,单晶,廖慧钰,黄云丽,韩莹,张小丹,杜晓菲,任美欣,边新渠,刘燕敏. 甲基强的松龙治疗药物性肝损伤患者临床及实验室特点分析^*[J]. 实用肝脏病杂志, 2019, 22(2): 208-211.

Huang Chunyang, Shan Jing, Liao Huiyu, Huang Yunli, Han Ying, Zhang Xiaodan, Du Xiaofei, Ren Meixin, Bian Xinqu, Liu Yanmin. Clinical and laboratory characteristics of patients with drug-induced liver injury receiving glucocorticoid therapy[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(2): 208-211.

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甲基强的松龙治疗药物性肝损伤患者临床及实验室特点分析^*

Clinical and laboratory characteristics of patients with drug-induced liver injury receiving glucocorticoid therapy

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