107例药物性肝损害的病因和临床特点

Causative agents and clinical features of 107 patients with drug-induced liver disease

目的对药物性肝病患者进行分析,以提高对该病的认识,及早做出正确诊断和治疗。方法对1992～2004年间我院住院的124例药物性肝病患者进行回顾性分析,并根据1997年Maria药物性肝损害评分系统重新评价。结果124例中Maria评分≥14分者107例。涉及药物频率由高到低依次为:抗生素28%(29/107),免疫抑制剂18.4%(19/107),中药及减肥茶13.8%(16/107),解热抗炎药10.3%(11/107),心血管类药9.2%(10/107),性激素类药8.0%(8/107),抗甲状腺亢进及降糖药4.6%(5/107),其他8.0%(9/107)。临床分型:肝细胞损伤型58.6%(62/107),胆汁淤积型26.5%(28/107),混合型14.9%(17/107)。80%患者1个月内肝功能恢复正常,7%(7/107)患者肝功能异常持续半年以上,仅1例死亡。结论抗生素引起的肝损害最常见,免疫抑制剂和中药引起的肝损害逐渐增多,停用有关药物后大部分患者预后良好,少数可引起肝硬化。

Objective To describe the clinical features of drug-induced liver disease, in order to improve the diagnosis and treatment of drug-induced liver disease. Methods One hundred and seven cases of drug-induced liver disease admitted to our hospital from 1992 to 2004 were reviewed retrospectively. Results The offending agents could be classified as follows： antimicrobial agents （28%）, immunosuppressive agents （ 18. 4%）, herbal medicine （ 13. 8%）, nonsteroidal anti-inflammatory drugs （ 10. 3%）, cardiovascular drugs （9.2 % ）, sex steroids （ 8 % ）, endocrinal drugs （4.6 % ） and mescillaneous （ 8.0 % ）. 58.6 % （62/107） were classified as hepatocellular type, 26.5% （28/107） as cholestatic type, and 14.9% （17/107） as mixed type. 93% patients recovered within 6 months, only one patient died. Conclusions A thorough history of medication should be taken in all patients presenting with abnormal liver function tests. Antimicrobial drugs, immunosuppressive drugs and herbal medicine were the most frequent hepatoxic factors in this sesies. In the majority of cases, the liver injury was resolved after prompt withdrawal of the relevant drugs, but in some cases, the liver injury was severe, and may progress to liver cirrhosis.