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독성간염의 임상적 고찰과 조직소견

Clinical Characteristics and Pathological Findings in Patients with Toxic Hepatitis

김영석|김희경|정승원|김홍수|김상균|장재영|이윤나|이세환|김부성|임재희
대한내과학회 (The Korean Association Of Internal Medicine)|2011.07|대한내과학회지 (The Korean Journal of Medicine)|제81권 제1호|pp. 53-63

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키워드

Prognostic factorsPathologyToxic hepatitis독성간염; 조직병리학; 예후인자
주제분류내과학

초록

Background/Aims:Although many individual cases of toxic hepatitis have been reported, there are few comprehensive systematic studies and few reports of the pathological findings in toxic hepatitis. We studied the clinical characteristics, pathology, and prognosis of patients with toxic hepatitis. Methods:A retrospective analysis examined the medical records of 184 cases of toxic hepatitis diagnosed from January 2004 to January 2010. Liver biopsies were performed in 62 of these cases. Patients were included in this study it they had a RUCAM score ≥4. Results:The incidence was higher in women (n = 125) than in men (n = 59). The mean age of the patients was 45.9 ± 14.4 years. The most common symptom was jaundice (56/184; 30.4%). The causative agents of the disease included herbal medications (43.5%), traditional therapeutic preparations (33.7%), and prescribed medications (21.7%). The pathological findings of toxic hepatitis included necrosis (n = 62), cholestasis (n = 43), steatosis (n = 23), eosinophilic infiltrations (n = 22), and ballooning degeneration (n = 20). The patients with cholestasis and necrosis were hospitalized longer and showed delayed recovery. The only prognostic factor associated with the hospitalization and recovery periods was the serum total bilirubin at the time of admission (p < 0.001). Conclusions:The common pathological findings of toxic hepatitis were necrosis and cholestasis, although these are not specific to toxic hepatitis. Only the total bilirubin at the time of admission was significantly associated with the duration of hospitalization and recovery. (Korean J Med 2011;81:53-63)

Abstract

Background/Aims:Although many individual cases of toxic hepatitis have been reported, there are few comprehensive systematic studies and few reports of the pathological findings in toxic hepatitis. We studied the clinical characteristics, pathology, and prognosis of patients with toxic hepatitis. Methods:A retrospective analysis examined the medical records of 184 cases of toxic hepatitis diagnosed from January 2004 to January 2010. Liver biopsies were performed in 62 of these cases. Patients were included in this study it they had a RUCAM score ≥4. Results:The incidence was higher in women (n = 125) than in men (n = 59). The mean age of the patients was 45.9 ± 14.4 years. The most common symptom was jaundice (56/184; 30.4%). The causative agents of the disease included herbal medications (43.5%), traditional therapeutic preparations (33.7%), and prescribed medications (21.7%). The pathological findings of toxic hepatitis included necrosis (n = 62), cholestasis (n = 43), steatosis (n = 23), eosinophilic infiltrations (n = 22), and ballooning degeneration (n = 20). The patients with cholestasis and necrosis were hospitalized longer and showed delayed recovery. The only prognostic factor associated with the hospitalization and recovery periods was the serum total bilirubin at the time of admission (p < 0.001). Conclusions:The common pathological findings of toxic hepatitis were necrosis and cholestasis, although these are not specific to toxic hepatitis. Only the total bilirubin at the time of admission was significantly associated with the duration of hospitalization and recovery. (Korean J Med 2011;81:53-63)

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