两种药物性肝损伤诊断评分标准的临床应用比较

目的比较我国药物性肝损伤常用的两种诊断方法的临床应用价值。方法分别用国内新标准和Danan标准,对212例临床诊断为药物性肝损伤的患者进行重新诊断,比较两种诊断方法之间的差异及一致性。结果 212例病例中,按国内新标准初步诊断确诊112例(52.8%),疑似病例91例(42.9%),排除9例(4.2%);疑似病例进行RUCAM简化评分系统再评分:极有可能7例,很可能有关50例,可能有关32例,可能无关2例,分别占疑似病例的7.7%、54.9%、35.2%、2.2%;按Danan标准诊断:极有可能48例(22.6%),很可能有关113例(53.3%),可能有关41例(19.3%),可能无关0例,无关10例(4.7%)。两种诊断标准比较差异有统计学意义(P<0.05),且一致性一般,故仍有偏差存在,主要原因为国内新标准仅节选了部分RUCAM评分系统。结论国内新标准较Danan标准简便易行且准确性较高,更适于我国药物性肝损伤的临床应用,但仍有需要改进之处。

Clinical application analysis of two diagnostic criteria for drug-induced liver injury

Objective To compare and analyze the clinical application value of two diagnostic criteria of drug-induced liver injury.Methods The new diagnostic criteria in China and Danan diagnostic criteria were applied to rediagnose 212 cases who diagnosed clinically drug-induced liver injury,and then the differences and consistency of the two diagnostic results were compared.Results In 212 cases,by the new diagnostic criteria in China,112 cases(52.8%) were diagnosed,91 cases(42.9%) were suspected,9 cases(4.2%) were excluded,and in the 91 suspected cases,7 cases(7.7%),50 cases(54.9%),32 cases(35.2%) and 2 cases(2.2%) were highly probable,probable,possible and unlike respectively by RUCAM simplified scoring system.By Danan diagnostic criteria,48 cases(22.6%),113 cases(53.3%) and 41 cases(19.3%) were classified as highly probable,probable and possible respectively,while none was unlike,10 cases(4.7%) were excluded.There were significantly differences in the two diagnostic criteria,which standed general in consistency.So there was still deviation existed.The reason might mainly lie in the new diagnostic criteria in China which were excerpts from just some of RUCAM simplified scoring system.Conclusion The new diagnostic criterion in China is more consistent with clinical applications than Danan diagnostic criteria of drug-induced liver injury in our country.However,there is still need further improvement.