药物性肝病218例病因及临床分析

Etiological and clinical analysis of 218 cases of drug-induced liver disease.

目的探讨药物性肝病的常见诱发药物、临床表现、分型及预后。方法对符合诊断标准的218例药物性肝病的临床资料进行回顾性分析。结果诱发药物性肝病的药物中,中草药占46例(21%),抗结核病药占45例(21%),解热镇痛药占22例(10%),抗菌药占17例(8%),化学治疗药占27例(12%),其它占62例(28%)。临床表现为急性药物性肝病198例(91%),其中急性肝炎型45例,胆汁淤积型111例,混合型42例;慢性药物性肝病20例(9%)。治愈168例(77%),好转28例(13%),无变化5例(2%),恶化8例(4%),死亡9例(4%)。结论药物性肝病常见的诱发药物为中草药、抗结核病药、化学治疗药及解热镇痛药等,主要为急性病程,预后良好。

Objectives： To investigate the etiology, clinical features, classification and prognosis of drug-induced liver disease （DILD）. Methods： The clinical data of 218 patients fulfilled the diagnostic criteria were reviewed and analyzed. Results： The etiological agents could be identified as followings： drugs, chinese herbal （46 cases, 21% ）, antiturbercular agents （45 cases, 21% ） , analgesic-antipyretic drugs （22 cases, 10% ） , antibiotics （17 cases, 8% ） , anti-tumor agents （27 cases, 12% ） , and miscellaneous （62 cases, 28% ）. There were 198 patients （91%） presented as acute liver injury with 45 cases （21%） of acute hepatitis, 111 cases （51%） of acute cholestatic type and 42 cases （ 19% ） of mixed type. Twenty cases （9%） presented as chronic liver disease. There were 168 cases （77%） cured, 28 cases （ 13% ） improved, 5 cases （2%） in stable condition, 8 cases （4%） deteriorated and 9 eases （4%） died. Conclusion： Drugs, chinese herbal, antiturbercular agents, analgesic-antipyretie drugs and antitumor agents are common etiological agents of DILD. Most patients present as acute liver injury and have a good prognosis.