药物性肝损伤患者血清脂肪酸结合蛋白FABP4水平变化及其临床意义

目的探讨FABP4在DILI中的表达及其与实验室相关指标在DILI损伤类型、临床结局评估中的应用价值。方法纳入上海交通大学医学院附属瑞金医院感染科2016年1月至2017年12月DILI患者158例。收集病史资料、实验室相关指标、发病14 d内血清。比较患者不同损伤类型、临床结局间FABP4的表达。并对患者实验室指标、临床结局进行相关性分析。结果158例DILI患者中,女性(111/158)居多,肝细胞损伤型79例(50.0%),混合型27例(17.1%),胆汁淤积型52例(32.9%)。100例(63.3%)患者恢复正常,42(26.6%)例患者慢性化,16例(10.1%)患者发生由于DILI的肝移植或者死亡。患者血清FABP4水平肝细胞损伤型为(9.83±1.40)ng/mL,混合型为(12.70±1.42)ng/mL,胆汁淤积型为(23.05±3.48)ng/mL。6月内恢复患者FABP4为(11.58±1.31)ng/mL,慢性化患者为(14.47±1.67)ng/mL,死亡/肝移植患者为(36.18±10.07)ng/mL较前两者均显著增高。结论血清FABP4在胆汁淤积型DILI、死亡/肝移植组显著增高,并分别与血清ALT、总胆红素、损伤类型、临床结局显著相关,血清FABP4可在一定程度上提示DILI患者的病程及转归。

Serum fatty acid binding protein 4 in patients with drug-induced liver injury

Objective To investigate the potential value of serum FABP4 level and some laboratory indicators in classification and prognosis of DILI.Methods DILI patients,admitted to the Department of Infectious Diseases,Ruijin Hospital,from January 2016 to December 2017,were enrolled.History data,laboratory indicators,and serum within 14 days of onset were collected.The expression of FABP4 was compared among different clinical classifications and outcomes,respectively.Kendall correlation analysis was performed on various clinical data,laboratory indicators and clinical outcomes.Results One hundred and fifty-eight patients,including 111 females,had different types of liver injury:hepatocellular injury(50.0%,79/158),mixed injury(17.1%,27/158)and cholestatic injury(32.9%,52/158).According to clinical outcomes,patients were divided into three groups,including 100 of recovery within 6 months(63.3%),42 of chronicity(26.6%)and 16 of liver transplantation or death due to DILI(10.1%).Furthermore,serum FABP4 levels in patients with different types of liver injury were 9.83±1.40 ng/mL(hepatocellular injury),12.70±1.42 ng/mL(mixed injury)and 23.05±3.48 ng/mL(cholestasic injury),respectively.Serum FABP4 level was significantly increased in chronic patients(14.47±1.67 ng/mL)compared with patients who recovered within 6 months(11.58±1.31 ng/mL).It was also notably higher in death/liver transplantation group(36.18±10.07 ng/mL)than the other two groups.Conclusion Serum FABP4 was significantly increased in the cholestasis DILI and death/liver transplantation groups,which was significantly associated with ALT,total bilirubin,outcome and clinical injury type.Serum FABP4 level might be a valuable factor in the prognosis of DILI to some extent.