急性及慢性药物性肝损害患者肝功能及自身抗体检测的临床意义

目的 探讨急性及慢性药物性肝损害患者肝功能及自身抗体检测的临床意义,为临床诊断及鉴别诊断药物性肝损害提供依据.方法 回顾性分析北京佑安医院2006-2008年收治的药物性肝损害患者51例的临床资料,将其分为急性药物性肝损害及慢性药物性肝损害两组,并对两组患者肝功能及自身抗体的检测结果进行分析对比.对数据用SPSS10.0软件进行Mann-Whitney秩和检验.结果 急性及慢性药物性肝损害两组患者ALT水平分别为(412.1±387.5)U/L和(376.0±319.7)U/L,AST为(352.5±457.9)U/L和(198.8±142.7)U/L,总胆红素为(109.7±104.8)μmol/L和(102.4±135.7)μmol/L,直接胆红素为(66.4±73.3)μmoL/L和(61.2±72.1)μmol/L,碱性磷酸酶为(133.4±50.1)U/L和(147.4±97.3)U/L,γ-谷氨酰转肽酶为(139.9±134.1)U/L和(180.6±227.9)U/L,白蛋白为(41.3±4.9)g/L和(39.8±5.3)g/L,球蛋白为(25.1±5.3)g/L和(28.6±5.1)g/L,经秩和检验分析,两组患者除球蛋白的水平差异有统计学意义外(P<0.05),其余指标的差异均无统计学意义(P>0.05).两组患者中部分可检出自身抗体,急性药物性肝损害组抗核抗体(ANA)、平滑肌抗体滴度均≤1:320;慢性药物性肝损害患者中可检出高滴度ANA、抗线粒体抗体,其中ANA滴度≥1:320的患者15例,7例患者ANA为1:1000.结论 肝功能指标无助于鉴别急性或慢性药物性肝损害;药物性肝损害患者可检测出多种自身抗体,慢性药物性肝损害患者可出现高滴度自身抗体,应注意与自身免疫性肝炎鉴别诊断.

Clinical significance of liver function and autoantibodies in patients with acute or chronic drug-induced liver injury (DILI)

Objective To investigate the clinical significance of liver function and autoantibodies in patients with acute or chronic drug-induced liver injury. Methods 51 patients with drug-induced liver injury were divided into acute drug induced liver injury group and chronic drug induced liver injury group, liver function and autoantibodies were compared between these two groups. Results There was no significant difference (P > 0.05) in alanine aminotransferase (412.1 ± 387.5) U/L and (376.0 ± 319.7) U/L], aspartate aminotransferase (352.5 ± 457.9) U/L and (198,8 ± 142.7) U/L], total bilirubin (109.7 ± 104.80) μmol/L and(102.4±135.7) μmol/L], direct bilirubin (66.4±73.3) μmol/L and (61.2±72.1)μ mol/L], alkaline phosphatase (133.4 ± 50.1) U/L and (147.4 ± 97.3) U/L], γ-glutarnyltransferase (139.9 ±134.1) U/L and (180.6 ± 227.9) U/L], and albumin (41.3 ± 4.9) g/L and (39.8 ± 5.3)g/L] between these two groups, however, the level of globulin (25.1 ±5.3) g/L and (28.6 ± 5.1) g/L] was significantly different between these two groups (P < 0.05). The titers of Anti-nuclear antibody(ANA) and smooth muscle antibody (SMA) were ≤ 1:320 in patients with acute drug induced liver injury. The titers of ANA,antimitochondrial antibody (AMA), and SMA were ≥ 1:320 in most of the patients with chronic drug induced liver injury. Conclusion Liver function has no value in the diagnosis of acute or chronic drug induced liver injury. High titer autoan-tibodies are found in patients with chronic drug induced liver injury.