| Objective:1.The serological levels of GGT and ALP in the three clinical types of drug-induced liver injury were analyzed and compared.2.Compare the consistency of the three classification methods for drug-induced liver injury,that is,the classification standard formulated by the international medical council(CIOMS)(calculating the R value),the classification based on pathological liver injury,and the classification based on the calculation of "R" value using GGT instead of ALP.3.The positive rate and degree of increase of GGT and ALP in drug-induced liver injury and autoimmune hepatitis and their value in differential diagnosis were analyzed and compared.Methods:A total of 337 patients with drug-induced liver injury and 120 patients with autoimmune hepatitis admitted to the department of hepatobiliary and pancreatic medicine of the first hospital of jilin university from January 2009 to December 2018 were collected.General data including gender and age,liver function examination,liver biopsy and other clinical data were collected.All data were statistically analyzed using spss22.0 software.Three DILI typing methods were set,that is,according to the standards set by the international council of medical organizations(CIOMS)(calculated R value,R=(ALT measured value /ALT ULN)/(ALP measured value /ALP ULN));according to the recalculated value(" R " =(ALT measured value /ALT ULN)/(GGT measured value /GGT ULN));according to the liver biopsy pathology.At the same time,DILI was divided into three types according to the above three types: hepatocellular injury type,cholestasis type and mixed type.Results:1.In DILI,there were 121 males(35.9%)and 216 females(64.1%),with more female patients than males.In DILI,the minimum age is 16 years old,and the maximum age is 84 years old.The average age is 49.1 13.26 years old,and the most common age is 41-60 years old(57.3%).There were 273 cases of acute DILI(81.0%)and 56 cases of chronic DILI(16.6%).DILI was eventually cured in 10 cases(3%),improved in 308 cases(91.4%),and recovered or died in 19 cases(5.6%).2.GGT levels in males and females were 226.2U/L(124.0U/L-400.9 U/L)and 184.2U/L(101.0U/ l-332.7 U/L),respectively.GGT levels in males were higher than that in females,and the difference was statistically significant(P < 0.05).The differences of ALP and GGT levels among different age groups were statistically significant(P < 0.05).GGT level is the highest in > 60 years old age group,significantly higher than other age groups.ALP level was highest in the age group 20 years old,equivalent to > age group 40 years old,significantly higher than that of 21-40 years old.There were no significant differences in serum GGT and ALP levels between traditional Chinese medicine and western medicine,between acute and chronic DILI,and among the three prognostic conditions(P > 0.05).3.(1)according to the classification criteria formulated by CIOMS(R value was calculated),337 patients with DILI were divided into three clinical types,including 179 patients with liver cell injury(53.1%),31 patients with cholestasis(9.2%),10 patients with mixed type(3.0%),and 117 patients with unclassified "liver biochemical abnormalities"(34.7%).GGT and ALP levels were different among the three clinical types,and the differences were statistically significant(P < 0.05).GGT and ALP levels in mixed type and cholestasis type were significantly higher than those in hepatocyte injury type.(2)according to the microscopic pathological manifestations of 69 patients undergoing liver biopsy,the patients were divided into three clinical types,including 31 cases of liver cell injury(44.9%),5 cases of cholestasis(7.3%),and 33 cases of mixed type(47.8%).The levels of GGT and ALP in the three clinical types were compared,and the differences were not statistically significant(P > 0.05).(3)according to the "R" value calculated by GGT instead of ALP,there were 68 cases of hepatocyte injury(20.2%),39 cases of cholestasis(11.6%),8 cases of mixed type(2.4%),and 222 cases of "liver biochemical abnormality"(65.9%).GGT and ALP levels were significantly different among the three clinical types(P < 0.05),among which GGT and ALP levels of mixed type and cholestasis type were significantly higher than those of hepatocyte injury type.4.In the consistency comparison between the clinical typing standards based on CIOMS and the two typing methods for calculating "R" value based on GGT instead of ALP,the consistency coefficient Kappa value of the two typing methods was 0.436(P<0.001),with good consistency.In the consistency analysis of pathological typing and CIOMS typing,as well as the scoring based on the "R" value calculated by GGT instead of ALP,Kappa values were 0.004 and 0.133 respectively,both <0.4.The consistency between pathological typing and other two typing methods was poor.5.In DILI,the positive rate of GGT and ALP is 92.3% and 66.5% respectively.The increase of GGT was concentrated in 2-4uln and > 4ULN,accounting for 72.2%.The increase of ALP was concentrated in normal value and 1-2uln,accounting for 84.2%.In AIH,the positive rate of serum GGT was 86.7%,which was higher than the positive rate of serum ALP,which was 73.3%.The highest proportion of increased GGT was 41 cases of > 4ULN(34.2%),and the highest proportion of increased ALP was 53 cases of 1-2uln(44.2%).6.The serum GGT level of DILI was higher than AIH,while the ALP level was lower than AIH.There were significant differences in the positive rate and degree of serum ALP in DILI and AIH(P < 0.05).The positive rate of ALP in AIH(73.3%)was higher than that of DILI(66.5%),while there was no significant difference in the positive rate and degree of increase of serum GGT between the two.7.Differential diagnosis from AIH DILI,ALP,GGT,both in the area under the ROC curve were 0.566,0.435,0.659,GGT area under the curve in the diagnosis of DILI < 0.5,diagnostic performance is poor,ALP,GGT both joint area under the ROC curve is the largest,but by comparing three kinds of detection combination area under the curve,difference was not statistically significant(p > 0.05),namely,GGT and ALP did not improve the efficiency in the diagnosis of DILI;Compared with GGT,ALP has high specificity and low sensitivity in diagnosis of DILI,but the combined test of ALP and GGT will significantly improve the specificity of diagnosis of DILI(100%).Conclusion:1.Compared with GGT,ALP has high specificity and low sensitivity in diagnosing DILI from AIH.The combined test of ALP and GGT will significantly improve the specificity in diagnosing DILI.2.The positive rate and degree of GGT increase in DILI are significantly higher than that in ALP.3.In DILI,the clinical classification calculated by biochemical indexes cannot reflect the true pathological manifestations. |
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