药物性肝病71例临床分析

Clinical analysis of 71 cases with drug-induced liver disease

[背景]探讨药物性肝病的病因及临床特点.[病例报告]采用回顾性分析方法对71例药物性肝病住院患者的用药史、临床表现、实验室检查结果及治疗效果进行调查分析.结果表明引起71例药物性肝病的相关药物中中药为17例(23.9%),抗结核类药物为16例(22.5%),抗生素类药物为13例(18.3%),抗肿瘤药物为9例(12.7%),解热镇痛药物为7例(9.9%),抗甲状腺类药物为4例(5.7%),中枢神经系统药物为2例(2.8%),其他为3例(4.2%).药物性肝病临床表现多样,无特异性.临床分型以胆汁淤积型最常见,为30例(42.3%),其次为肝细胞型,为28例(39.4%),其他为混合型,为13例(18.3%).经停用致肝损伤药物及给予保肝等治疗,70例(98.6%)预后良好,1例(1.4%)发展为肝硬化.[讨论]药物性肝病多由中药、抗结核药及抗生素类药物引起,主要类型为胆汁淤积型,其次为肝细胞型;大多数药物性肝病预后良好,少数病例可发展为重症肝炎或肝硬化.

BACKGROUND To investigate the etiological factors and clinical characteristics of patients with drug-induced liver disease. CASE REPORTS The medication history, clinical manifestation, laboratory examination, and therapeutic effects were liver disease. There were the 17 cases（23.9%） of retrospectively analyzed in 71 cases of drug-induced traditional chinese medicine, 16 cases（22.5%） of antituberculous, 13 cases （18.3G） of antibiotics, 9 cases （12.7%） of antitumor, 7 cases （9.9%） of antipyretic analgesic, 4 cases（5.7%） of anti-thyroid, 2 cases（2.8%） of central nervous system agents and 3 cases（4.2%） of the others in 71 cases of drug-induced liver disease. The clinical manifestation of drugqnduced liver disease was multiplicity and had no particularity. The clinical types of drug-induced liver disease included 30 cases（42. 3%） of cholestasis, 28 cases（39.4%） of hepatic cells and 13 cases（18.3%） of mixed type. After the medicines inducing liver disease were stopped to use and administrating the hepatoprotection medicine, 70 patients （98.6%） were cured with good prognosis, and only one patient （1.4%） progressed to liver cirrhosis. DISCUSSION Most of the traditional chinese medicine,autituberculous, antibiotics, antitumor medicines are induced the drug-induced liver disease, and its main types are cholestasis, and most of drug-induced liver disease has a good prognosis but individual patients develop serious hepatitis and cirrhosis.