药物性肝损伤184例病因分析

Analysis of 184 cases of drug-induced liver damage

目的回顾分析南京医科大学附属南京医院(南京市第一医院)诊断为药物性肝损伤(DILI)病例,探讨药学监护和用药教育对DILI的意义。方法对2014年3月至2019年3月南京医科大学附属南京医院(南京市第一医院)DILI病人的临床资料,包括一般情况、临床诊断、肝功能指标、既往用药史、临床症状体征、其他实验室检查,然后进行统计分析。结果 240例诊断DILI的病人经因果关系评价表(RUCAM)量表筛选出184例。病人年龄范围18~85岁,年龄(56.13±14.21)岁,住院天数(11.40±5.66)d。严重程度分布为轻度损伤36例(19.56%),中度损伤52例(28.26%),重度损伤89例(48.37%),急性肝衰竭7例(3.8%)。起病前涉及药物用药天数的中位数为30 d。导致DILI的药物中,中药44例,中成药42例,降脂药物22例,解热镇痛药19例。结论导致DILI最常见的药物是传统中药、中成药、降脂药物和解热镇痛药。应加强对DILI的管理和预防,药师积极开展DILI相关的用药监护和用药教育工作,以降低DILI的发生。

Objective Toretrospectively review and analyze the cases of drug-induced liver injury(DILI)in Nanjing Hospital Af-filiated to Nanjing Medical University,and to probe the significance of pharmaceutical monitoring and medication education for DI-LI.MethodsClinical data of DILI patients in our hospital from March 2014 to March 2019,including general conditions,clinicaldiagnosis,liver function indexes,previous medication history,clinical symptoms and signs,other laboratory tests,were collected andanalysed.includedResultsA total of 184 cases were chosen from 240 cases of DILI by the Roussel Uclaf Causality AssessmentMethod(RUCAM).The patient’s age ranged from 18 to 85 years,the age was(56.13±14.21)years,and the length of hospital staywas(11.40±5.66)days.The severity distribution was 36 cases(19.56%)with mild injury,52 cases(28.26%)with moderate inju-ry,89 cases(48.37%)with severe injury,and 7 cases(3.8%)with acute liver failure.The median of intake duration of the in-volved drugs was 30 days.Among the drugs causing DILI,44 were Chinese medicines,42 were Chinese patent medicines,22 werelipid-lowering drugs,and 19 were antipyretic and analgesic drugs.ConclusionsThe most common drugs that induce DILI are tra-ditional Chinese medicine,Chinese patent medicine,anti-lipemic agents and antipyretic analgesics.The management and preventivemeasures of DILI should be strengthened.Pharmacists should pay attention to and actively carry out drug monitoring and medicationeducation about DILI to reduce the occurrence of DILI.