不同致病药物相关急性间质性肾炎的临床特点分析

To evaluate the clinical features and causative medicines of drugs associated AIN

目的分析肾活检患者中药物相关急性间质性肾炎(DAIN)的临床特点及常见致病药物的用药特点。方法回顾性分析2002年1月至2007年5月我院经肾活检诊断的DAIN患者的临床病理资料,比较不同药物所致DAIN的特点。结果急性间质性肾炎(AIN)患者共115例,占同期肾活检患者总数的4.0%,其中DAIN45例,占39.1%。在DAIN患者中抗生素、解热镇痛药、中药相关者分别占73.3%、26.7%、11.1%;其中19例(42.2%)合用两类药物。使用前3位的药物依次为β内酰胺类抗生素(51.1%)、解热镇痛药(26.7%)和喹诺酮类抗生素(22.2%)。消化道症状、乏力是DAIN最常见的全身表现,93%的患者出现急性肾衰竭(ARF)并伴肾小管功能受损,78%的患者出现肾性糖尿。根据用药种类的不同,患者初诊时可分别出现发热、皮疹,新出现的高血压、水肿,检查可见蛋白尿、血尿、无菌性白细胞尿、贫血、外周血嗜酸性白细胞升高等表现。其中,皮疹、血嗜酸性白细胞升高、无菌性白细胞尿常见于β内酰胺类抗生素相关AIN;喹诺酮类抗生素相关AIN者易发生血尿,但贫血相对较轻;解热镇痛药相关AIN的特征不突出。结论目前导致DAIN的药物仍以β内酰胺类抗生素最为常见,其次为解热镇痛类药物,喹诺酮类抗生素相关性AIN较前增多。DAIN临床症状缺乏特异性,用药后监测尿糖及肾功能的变化有助于早期发现DAIN,综合分析临床特点有助于判断致病药物。

Objective To investigate the clinical characteristics and causative medicines of drugs associated acute interstitial nephritis（DAIN）. Methods Clinical features of 45 cases diagnosed pathologically as DAIN during 2002-2007 were analyzed retrospectively. Results AIN accounted for 4. 0% of all the renal biopsy cases and 39.1% of those diagnosed as DAIN. Antibiotics,autipyretie anelgesics and herbal medication were related to 73.3 %,26.7% and 11.1% of DAIN cases respectively. 42.2% cases were due to the combination of two or more kinds of medicines. The first three causing drugs were β-lactam Antibiotics （51. 1%）, autipyretic anelgesics （26. 7%） and quinoloines（22.2%）. The most common presenting clinical features were digestive tract symptoms and hypodynamia. 93% cases had acute renal failure together with renal tubular dysfunction. 78% of the cases presented renal glyeosuria. Other clinical symptoms included fever,rash,hypertension and edema which varied with different drugs. Laboratory features were proteinuria, hematuria, leukoeyturia,eosinophil and anemia. Occurrence of rash,leukocyturia and eosinophil was more common in [3-1actam antibiotics associated AIN patients. Quinoloines associated AIN were easy to show hematuria, but without anemia. No distinct clinical or laboratory features could be detected in auti- pyretic anelgesics associated AIN patients. Conclusions β-lactam antibiotics is still the most common drug causing DAIN in China, which is followed by autipyretic anelgesics. Quinolones associated AIN cases are more than hefore.DAIN has no significant features. Monitoring the urinary glucose and renal function may contribute to the early detection of DAIN.