痔血胶囊单药致群发性肝损伤——附30例分析

Drug-induced liver injury related with Zhixue Capsules:An analysis of 30 gregarious patients

目的对我院14个月内收治的痔血胶囊单药(主要成分为白鲜皮和苦参)致群发性肝损伤病例进行回顾性分析。方法2007年8月至2008年10月在我院诊断为痔血胶囊相关性药物性肝损伤患者共30例,对其一般资料、临床表现及实验室检查结果进行CIOMS临床分型和回顾性分析。结果本组患者女性(25例)明显多于男性(5例),占83.34%;平均潜伏期为(48.83±26.66)d;平均服药时间为(27.43±12.04)d;27例患者在停药后起病,平均(25.53±20.95)d;生化表现主要为ALT、AST、TBil、ALP及GGT异常。有2例嗜酸性粒细胞>6%。临床分型:肝细胞损伤型16例,胆汁淤积型1例,混合型3例,未分型10例。所有患者均康复。结论痔血胶囊成分复杂,其引起的肝损伤以肝细胞损伤型为主,推测痔血胶囊相关性肝损伤的发病机制与患者对其中成分的特异质性反应有关。

Objective To analyze retrospectively 30 gregarious patients diagnosed as drug-induced liver injury （DILI） related with Zhixue Capsules （essential component is Dictamnus dasycarpus Turc2 and Sophora flavescens）. Methods The general information including clinical manifestation and laboratory tests of the 30 patients of DILI related with Zhixue Capsules were collected and analyzed according to CIOMS. Results The proportion of female cases was 83.34%. The average incubation period was （48.83 ± 26.66） d. The average time for medication were （27.43 ± 12.04） d. The average time from the drug withdrawal to the onset were （25.53 ± 20.95）d. Increased ALT, AST, TBil, ALP and GGT were mainly observed. The eosinophil count of one patient was more than 6%. Sixteen patients were classified as hepatocellular type, 1 as cholestatic type, 3 as mixed type and 10 were unclassified. All patients were cured. Conclusion The hepatoeellular type was the major one in these patients. The pathogenesis of DILI related with Zhixue Capsules was likely to associated with idiosyncratic reactions of patients to the componets of Zhixue Capsules.