药物性肝病与急性乙型肝炎临床特征及预后对比分析

Contrasting Analysis on Clinical Features and Prognosis of Drug-induced Liver Disease and Acute Hepatitis B

目的:分析引起药物性肝病的主要药物及其临床特点与转归。方法:临床诊断药物性肝病患者167例,急性乙型肝炎患者103例,应用SPSS11.5统计软件分析两组患者症状、体征及肝脏生化等指标。结果:引起药物性肝病主要的药物是治疗皮肤病、风湿性疾病的中草药,抗生素、降压药及降糖药等;药物性肝病女性患者明显高于急性乙型肝炎组,P<0.001,临床表现中发热、皮疹及自身抗体阳性率较急性乙型肝炎患者高;急性乙型肝炎患者丙氨酸转移酶、天门冬氨酸氨基转移酶水平明显高于药物性肝病患者(P<0.05)。结论:导致药物性肝病的主要药物为中草药、抗生素、降压药,药物性肝病女性患者数、发热及皮疹等临床体征及自身抗体阳性率高于乙型肝炎患者。

Objective： To investigate the main category of drugs causing liver disease and the clinical characteristics and prognosis of drug-induced liver disease （DILD） comparing with acute hepatitis B （AHB）. Methods： Data of 167 cases （male 68, female 99） of DILD with average age of 46.8, and 103 cases （male 85, female 18） of AHB with average age of 37.8 were collected and indexes of symptoms, physical signs and liver biochemistry were analyzed with software of SPSSll. 5. Results： The main liver disease-causing drugs including Chinese herbal medicines for dematopathy and rtheumatic disease （57.5%）, antibiotics （ 12.6% ）, hypotensive drugs （9.0%）, and drugs for diabetes and other diseases （20.9%）. Female patients occupied 59.3% of DILD which was significantly higher than the ratio （17.5%） of female patients in AHB cases （P 〈0.001 ）. The main symptoms of DIED were fever,skin rash and higher autoantibody, and about 19.8 % of patients were diagnosed by patho- logical observation on tissue from liver paracentesis. The average time for drugs causing damage in liver was 20.5 months （3 days-21 years）. The case fatality of DILD was 1.2% while that of AHB was 0%. The levels of ALT and AST of AHB patients were significantly higher than those of DILD patients （ P 〈 0.05）. No obvious difference was found in levels of TBIL, ALP, GGT and CHE between DILD pa- tients and AHB patients. Conclusions： The DILD-causing drugs are mainly Chinese herbal medicines, antibiotics, and hypotensive drugs. The clinical features of DILD are fever, skin rash, increasing of autoantibody, and lower ALT level, and that there are more female patients than male. The prognosis of DILD is good.