111例抗结核药致肝损伤住院病例调研分析

目的评价我国急性药物性肝损伤诊断标准与国际标准RUCAM评分系统的一致性。方法采用国际共识会议诊断标准和我国急性药物性肝损伤诊断标准对111例抗结核药致肝损伤病例进行回顾性调查分析。结果111例抗结核药导致的肝损伤中，101例符合美国药物性肝损伤网络提出的资料完整性标准。按照国际共识意见进行临床分型：肝细胞型81例（80.2％），胆汁淤积型16例（15.8％），混合型4例（4.0％）。采用RUCAM量化评分系统评分结果是：非常可能2例（2.0％），很可能63例（62.4％），可能32例（31.7％），不大可能4例（4.0％），无关0例；采用我国急性药物性肝损伤诊断标准对人选病例进行评定：确诊38例（37.6％），疑似57例（56.4％），排除6例（5.9％）。结论抗结核药致肝损伤的临床特点符合急性药物性肝损伤的临床规律。我国急性药物性肝损伤临床诊断方法简便，町操作性强，与RUCAM评分有较强的相关性。

Clinical characterization for 111 cases of patients with antituberculosis drug-induced liver injury

Objective and international standard To evaluate the concordance between for RUCAM scoring system. Methods Chinese standard for the acute drug-induced liver injury The concordance between Chinese standard for the acute drug-induced liver injury and international standard for RUCAM scoring system was estimated by analyzing 111 cases of patients with antituberculosis （anti-TB） drug-induced liver injury. Results Among 111 inpatients, data for 101 cases were integrity according to the standard for American drug-induced liver injury network. According to clinical classification for international consensus view, there were 81 cases （80.2%） for hepatitis type, 16 cases （ 15.8% ） for cholestasis type, and 4 cases （4.0%） for mixed type. The results based on RUCAM scoring system were as follows： 2 cases （2.0%） were highly probably relevant, 63 cases （62.4%） probably relevant, 32 cases （31.7%） possibly rele- vant, 4 cases （4.0%） possibly irrelevant, 0 case irrelevant. The results based on Chinese standard for the acute druginduced liver injury were as follows： 38 cases （37.6%） were final diagnosis, 57 cases （56.4%） doubtful diagnosis, 6 cases （5.9%） depletion diagnosis. Conclusion Clinical characteristic of anti-TB drug-induced liver injury cases is consistent with clinical rule of acute drug-induced liver injury in China. The Chinese standard for acute drug-induced liver injury which is very useful for clinical doctor and easy to use in clinical practice is well correlated with RUCAM scoring system.