Clinical and Molecular Hepatology (대한간학회지)

The Korean Association for the Study of the Liver (대한간학회)
권호 표지

Clinical characteristics of 159 cases of acute toxic hepatitis

급성 독성간염 159예의 임상적 고찰

Kang, Sun-Hyung;Kim, Jeong-Il;Jeong, Kyung-Hye;Ko, Kwang-Hoon;Ko, Pyung-Gohn;Hwang, Se-Woong;Kim, Eun-Mi;Kim, Seok-Hyun;Lee, Heon-Young;Lee, Byung-Seok
강선형;김정일;정경혜;고광훈;고평곤;황세웅;김은미;김석현;이헌영;이병석

  • Published : 20080000
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Abstract

Backgrounds/Aims: Toxic hepatitis has recently been discovered to be a major cause of acute hepatitis. We studied the clinical features and prognosis of patients diagnosed with toxic hepatitis at a single institution. Methods: A retrospective analysis was performed using medical records of 159 cases of toxic hepatitis that were diagnosed from March 2003 to March 2008. Patients were selected based on a RUCAM score of 4 or above. Results: The incidence was higher in women (n=97) than in men (n=62). The age (mean±SD) of the patients was 51±15 years . The major causes of the disease included the use of Korean traditional therapeutic preparations (34.0%), herbal medicines (41.5%), and drugs prescribed by a physician (23.9%). At the time of admission, jaundice was the most common symptom (41.5%), and the results of a liver serum battery were as follows: aspartate aminotransferase, 729.4±877.0 IU/L; alanine aminotransferase, 857.1±683.0 IU/L; total bilirubin, 6.4±6.5 mg/dL; and alkaline phosphatase, 209.8±130.0 IU/L. The hospitalization period was 10.0±9.5 days, and the duration of recovery from liver injury was 31.0±29.5 days. The factors associated with the hospitalization period included the presence of anorexia and the serum levels of albumin and bilirubin at the time of admission (P<0.05). A high serum bilirubin level and a history of alcohol ingestion were associated with a delayed recovery (P<0.05). The sex, age, BMI, and duration of medication were not significantly related to the hospitalization and recovery periods. Conclusions: The main cause of acute toxic hepatitis in the current study was the use of herbal medicines. The severity of liver injury at the time of admission was a major factor significantly associated with the hospitalization and recovery periods. (Korean J Hepatol 2008; 14:483-492)

목적: 최근 급성 간염의 많은 원인이 독성간염으로 밝혀지고 있지만 아직 그 빈도나 임상양상, 예후에 대해서는 연구가 부족한 실정이다. 이에 연구자들은 단일 기관에서 독성간염으로 진단받은 환자들에 대해서 임상양상과 예후에 대해서 알아보고자 하였다. 대상과 방법: 2003년 3월부터 2008년 3월까지 단일 기관에서 독성간염으로 진단받은 환자 159예를 대상으로 의무기록을 바탕으로 후향적으로 분석하였다. Modified RUCAM score를 이용하여 4점 이상인 환자들을 대상으로 하였고 간손상의 형태는 혈청 간효소치를 이용한 R값(ALT/ALT 상한치/ALP/ALP 상한치)에 따라 간세포형, 담즙정체형, 혼합형으로 분류하였다. 모든 환자에서 A형, B형, C형간염에 대한 검사를 시행하였으며 자가면역간염 등의 다른 간염의 원인을 배제하였다. 결과: 독성간염의 남녀 비는 62:97로 여자가 더 많았고, 연령은 51.0±15.4(범위, 16~90세)였다. 원인은 민간약제에 의한 것이 34%(54/159), 한 의사가 처방한 한약이 41.5%(66/159)였으며, 의사 처방에 의한 약제가 23.9%(38/159)였다. 민간약제는 봉삼이 14예(8.8%)로 가장 많았으며, 의사가 처방한 약 중에서는 항생제가 14예(8.8%)로 가장 많았다. 증상은 황달이 41.5%로 가장 많았으며, 복통(32.7%), 피곤함(20.1%), 오심(20.1%), 구토(10.1%), 가려움증(10.1%)의 순이었다. 내원 시 혈청생화학검사 소견은 AST 729.4±877.0 IU/L, ALT 857.1±683.0 IU/L, 총 빌리루빈 6.4±6.5 mg/dL, ALP 209.8±129.5 IU/L, GGT 227.6±284.8 mg/dL였다. 간손상의 유형은 담즙정체형이 6.9%, 간세포형이 60.4%, 혼합형이 32.7%였다. 입원기간은 10.0±9.5일, 간기능 수치가 정상으로 회복되는 데 걸린 시간은 31.0±29.5일이었다. 다중회귀분석 시 입원기간은 내원 당시의 혈청 알부민 및 총 빌리루빈 수치와 연관이 있었으며 식욕부진이 있는 환자에서 입원기간이 길었다(P<0.05). 회복기간은 내원 당시의 혈청 총 빌리루빈 수치와 연관이 있었으며, 복통을 호소한 환자에서 회복기간이 짧았다(P<0.05). 성별이나, 연령, BMI, 음주 여부, 약제의 복용기간은 유의한 연관성이 없었다. 159예 중 2예에서 사망하였으며 각각 B형 간경변증과 알코올간경변증이 독성 악화된 경우였다. 결론: 급성 독성간염은 민간약제와 한약에 의한 원인이 대부분이었고 간세포형이 가장 많았으며 내원 당시의 간기능의 정도가 입원기간 및 회복기간을 결정하였다.

Keywords

References

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