담즙정체성 간염의 임상적 양상

Clinical Features of Cholestatic Hepatitis

담즙정체성 간염의 원인과 임상양상, 검사실 소견 및 경과를 알아보고자 1991년에서 2000년까지 영남대학교 의과대학 부속병원에서 혈액검사 및 간생검으로 담즙정체성 간염이 확진된 14명의 환자를 대상으로 후향적 연구를 시행하여 다음과 같은 결과를 얻었다. 담즙정체성 간염에서 비정상 간기능검사의 기간은 1개월에서 30개월까지 다양하게 나타났고, 항결핵제, 항생제에 의한 담즙정체성 간염이외에도 한약제, 건강식품에 의한 경우 검사실 소견과 임상경과가 중하게 나타나는 경우가 있으므로, 이들 약물을 사용한 병력이 있는 경우 정기적인 간기능 검사가 필요하다. 담즙정체성 간염이 만성 간내 담즙정체를 보이는 경우 바이러스에 의한 담즙정체성 간염과 담관소멸 증후군으로의 진행 유무, 원발성 담즙성 간경변증, 자가면역성 간염과의 감별이 필요하며, 지속적인 간기능 검사이상을 보일 경우에는 연속적인 간생검이 필요할 것으로 생각된다.

Background: Cholestatic hepatitis is failure of bile to reach the duodenum with hepatocellular damage and no demonstable obstruction of the major bile ducts. The prognosis is usually good with recovery in less than 4 weeks after withdrawal of the offending drug. However, a prolonged course lasting over 3 months is possible and, in rare cases, progression to ductopenia with development of a vanishing bile duct syndrome occurs. A differential diagnosis with other causes of Chronic liver disease is needed. Materials and Methods: From January 1991 through January 2000, 14 patients diagnosed as cholestatic hepatitis by liver biopsy were included. The possible causative drug, clinical features, laboratory findings, and progression of cholestatic hepatitis were evaluated. The semiquantitative study of liver lesions was performed by two independent observers. Results: Causes of cholestatic hepatitis are 5 cases of oriental medicine, 3 cases of anti-tuberculosis medication, 1 case of ticlopidine and antibiotics and 4 cases of unknown causes. The clinical features of cholestatic hepatitis were jaundice, itching, urine color change, and general weakness. During 6 to 30 months, LFT of 5 patients showed prolonged elevation. Elevated total cholesterol ${\geq}$250 mg/dL in 6 patients, pheripheral blood eosinophilia in 5 patients, auto-antibody positive in 6 patients were observed respectively. The biopsies showed intralobular bilirubinostasis with a mixed portal inflammatory infiltration. Conclusion: In cholestatic hepatitis, durations of abnormal LFT are variable regardless of causative drugs. If cholestatic hepatitis progresses toward chronic course, viral hepatitis, primary biliary cirrhosis, and autoimmune hepatitis should be differentially diagnosed and sequential liver biopsies are needed.