药物性肝病预后预测因子的回顾性研究

Retrospective Study on the Prognostic Factors for Prognosis of Drug-Induecd Liver Disease

目的对各类重症药物性肝病临床预后进行分析,以评估与预后相关的重要预测因子。方法将我院1997年以来疑为药物性肝病的患者的住院资料,根据实验室检查分为肝细胞型,胆汁淤积型和混合型。对患病与药物的因果关系进行量化评价。结果265例药物性肝病中女性占52.8%。肝细胞型肝损伤是最常见的的类型,占72.1%,该组患者的病死率是9.9%;而胆汁淤积型/混合型组的病死率是9.5%。死亡组与存活组患者年龄无差异,男女比例及住院时间两组亦相似;死亡组患者的总胆红素、直接胆红素和AST水平高于存活组。64例患者(24.2%)因为服用中草药而发生药物性肝病,9例患者因为服用抗结核药发生药物性肝病。与患者死亡相关的因素有:肝性脑病、腹水、黄疸、嗜酒、直接胆红素。结论我院药物性肝病患者的病死率是9.8%。最常见的致病药物是中草药。但是抗结核药物是造成患者死亡的首要原因。肝性脑病、腹水、黄疸、嗜酒和直接胆红素的水平与患者的死亡相关。

Objective To aualyze the prognosis of severe drug-induced liver disease and assess the related important prognosis predictors. Methods The data of the patients with suspicious drug-induced liver disease in our hospital were collected since 1997, The causality, between disease and drug was evaluated according to the quantification score chart. Results From 1997 to 2004, a total of 265 patients were diagnosed as drug-induced liver disease, in which 52.8% was female. Hepatocellular damage was the most common type （ 72.1% ）, the fatality rate in this group was 9,9%, whereas it was 9.5% in the group of cholestatic/mixed type. There was no significant difference in age, in the proportion of male and female, in the hospitalization time between death group and survival group. The level of serum total bilirubin, direct bilirubin and AST was higher in death group than in the other. 64 patients were diagnosed as drug-induced liver disease for Chinese herbal medicine, 9 patients were for anti-tuberculosis drugs. The factors related with death in patients were as following： hepatic encephalopathy, ascites, jaundice, alcoholism and direct bilirubin. Conclusions The fatality rate of drug-induced liver disease is 9.8% in our hospital. Chinese herbal medicine is themost common pathogenic drug. But anti-tuberculosis drugs are the primary causes for lethal in patients with drug-induced liver disease. And the death of patients is related to the level of hepatic encephalopathy, ascites, jaundice, alcoholism and direct bilirubin.