回顾性分析临床药物性肝病147例

Retrospective analysis of 147 cases of drug-induced liver disease

目的分析总结近年来本院药物性肝病（DILD）的情况,提高本病的诊断治疗水平。方法回顾调查本院2004年1月-2008年12月各种药物致药物性肝病147例,分析统计每年药物性肝病发病例数的变迁及临床情况。结果DILD发病率呈上升趋势,占同期急性肝炎的15.36%。引起此病的药物种类多,中药制剂、抗结核药、化疗药、抗菌药物、抗甲亢药是主要的损肝药物。其中中药制剂占34.01%,抗结核药占27.89%,抗肿瘤化疗药占10.20%,抗菌药物占8.84%,抗甲亢药占6.80%;用药1-3月出现肝损害占97.28%,无临床症状者占17.01%,有症状者占82.99%,主要表现为乏力、恶心、呕吐、尿黄、黄疸及肝大等。肝功能损伤表现为ALT、AST、TB、GGT及ALP明显升高。肝细胞损伤型92例,胆汁淤积型22例,混合型33例。经综合治疗后,95.92%治愈或好转,2.72%无变化或加重,1.36%死亡。肝细胞损伤型DILD患者治疗后肝功能较胆汁淤积型DILD患者恢复快。结论DILD发病率上升,涉及药物种类多,临床表现与病毒性肝炎相似,无特异性;药物性肝病的早期诊断与重视程度和认识有关,加强规范合理用药及用药监测可以预防本病。

Objective To analyze drug-induced liver disease（DILD） and improve its diagnosis and therapy.Methods A tatal of 147 cases of DILD from January,2004 to December,2008 were retrospectively analyzed.Results DILD increased in the last several years,accounting for 15.36% of the acute hepatitis admitted at the same period.A variety of drugs could cause DILD,among which Chinese traditional herbal drugs accounted for 34.01%,anti-tuberculosis drugs chemotherapeutic drugs 27.89%,chemotherapeutic drugs 10.20%.antibiotics 8.84%,and anti-hyperthyroidism drugs 6.80%.Among the 147 cases liver damage（97.28%） was present 4-12 weeks after drug administration.Among them 17.01% were non-symptomatic,whereas 82.99% were symptomatic.The main clinical features were enervation,nausea,vomiting,yellowish urine,jaundice and enlarged liver.Liver function damage was featured by elevation of serum ALT,AST,GGT,ALP,and TB.Among the 147 cases,92 were liver cell injury,22 were cholestasis,and 33 were mixed cases.Through comprehensive treatment,95.92% were cured or improved,2.72% did not change and 1.36% died.Patients with liver cell injury recovered better than those with cholestasis.Conclusion DILD tend to increase in recent years.Chinese traditional herbal drugs,anti-tuberculosis drugs,chemotherapeutic drugs and antibiotics are the most common causes for DILD.The clinical features are similar to those of viral hepatitis with no specificity.We should pay more attention to the drug-induced hepatotoxicity harm.Enhancing drug administration and patient monitoring might prevent DILD.