The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Clinical Characteristics and Pathological Findings in Patients with Toxic Hepatitis

독성간염의 임상적 고찰과 조직소견

  • Lim, Jae-Hee (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Young-Seok (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Yun-Nah (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Sang-Gyune (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jeong, Soung-Won (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Jang, Jae-Young (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Lee, Sae-Hwan (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Hong-Soo (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Boo-Sung (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Hee-Kyung (Department of Pathology, Soonchunhyang University College of Medicine)
  • 임재희 (순천향대학교 의과대학 부천병원 내과) ;
  • 김영석 (순천향대학교 의과대학 부천병원 내과) ;
  • 이윤나 (순천향대학교 의과대학 부천병원 내과) ;
  • 김상균 (순천향대학교 의과대학 부천병원 내과) ;
  • 정승원 (순천향대학교 의과대학 부천병원 내과) ;
  • 장재영 (순천향대학교 의과대학 부천병원 내과) ;
  • 이세환 (순천향대학교 의과대학 부천병원 내과) ;
  • 김홍수 (순천향대학교 의과대학 부천병원 내과) ;
  • 김부성 (순천향대학교 의과대학 부천병원 내과) ;
  • 김희경 (순천향대학교 의과대학 부천병원 병리과)
  • Published : 2011.07.01
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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 ${\geq}4$. Results: The incidence was higher in women (n = 125) than in men (n = 59). The mean age of the patients was $45.9\;{\pm}\;14.4$ 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.

목적: 독성간염에 관한 연구는 대부분 증례보고 형식이며 비교분석 연구 또는 조직소견에 대한 보고는 적다. 이에 저자들은 독성간염의 임상양상 및 조직소견과 예후와의 연관성에 대해 알아보기로 하였다. 방법: 2004년 1월부터 2010년 1월까지 독성간염으로 입원 치료 받은 환자 184명을 대상으로 후향적으로 분석하였다. 이중에서 간 조직검사를 시행 받은 환자는 62명이었다. 독성간염의 진단은 RUCAM 점수를 이용하여 4점 이상인 경우를 독성간염으로 간주하였다. 결과: 독성간염은 남자(n = 59)보다 여자(n = 125)에서 더 많이 발생하였다. 환자들의 평균나이는 $45.9\;{\pm}\;14.4$세이었고 입원 당시 가장 흔한 증상은 황달이었다. 원인약제는 한약이 80예(43.5%), 민간요법 62예(33.7%), 의사에 의한 처방 약물 40예(21.7%)로 한약이 가장 많았다. 조직소견은 간세포괴사(n = 62), 담즙정체(n = 43), 지방변성(n = 23), 호산구 침윤(n = 22) 그리고 풍선양 변성(n = 20) 순으로 관찰되었다. 조직학적으로 담즙정체와 간세포괴사가 있는 경우에 입원기간과 회복기간이 길었다. 입원 당시의 혈청 총 빌리루빈만이 입원기간 및 회복기간과 독립적 연관성이 있었다. 결론: 독성간염의 가장 흔한 조직소견은 간세포괴사와 담즙정체이다. 그러나 독성간염의 특이적인 조직소견은 아니다. 독성간염의 임상경과에 영향을 미치는 인자로는 입원 당시 혈청 총 빌리루빈수치가 높으면 입원이 길어지고 회복이 늦어질 수 있다. 하지만 연령, 성별, 약물 복용기간, 음주력 등은 유의한 연관성은 없었다.

Keywords

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