药物性肝损伤79例临床分析

Clinical analysis of drug-induced liver injury of 79 cases

目的探讨药物性肝损伤(drug-induced liver injury,DILI)的临床特点,为临床早期诊断和治疗提供依据。方法回顾性分析2005年1月至2009年6月79例DILI住院患者的临床资料。结果79例DILI中男性23例,女性56例(1∶2.43);年龄28～87岁,平均为50.4岁。中药致DILI最常见,其次分别为抗生素、抗结核药、解热镇痛药、抗肿瘤药及保健药。发病潜伏期为8d～半年,服抗生素出现DILI的潜伏期最短,其次为解热镇痛药和抗癌药。而中药、抗结核药、降压药、调脂药及保健药等潜伏期较长。68.4%为肝细胞损伤型,10.1%为胆汁瘀积型,21.5%为混合型。治疗结果70例好转,6例痊愈,2例未愈,1例死亡。结论多种药物长期大量应用均可引起DILI,一旦发现应及时对症治疗并定期复查肝功能。

ObjectiveTo discuss the overall clinical features of drug-induced liver injury （DILI） for early diagnosis and treatment.MethodsA retrospective analysis was conducted on 79 inpatients with DILI from January 2005 to June 2009.ResultsThere were 23 male and 56 female （1∶2.43）.Ages ranged from 28 to 87 years old （average 50.4 years）.The incidence rates of DILI due to Chinese herbs,antibiotics,antituberculotics,antipyretic-analgesics,antitumor agents and health care medicines were 22.8%,15.2%,11.4%,8.9%,7.6% and 5.1% respectively.The incubation periods of DILI ranged from 8 days to 6 months in the majority （89.9%）,and in the order of them,the period of antibiotics was the shortest,antipyretic-analgesics and antitumor agents next,Chinese herbs,antituberculotics,blood pressure-lowing agents,blood lipid-adjusting agents and health care medicines relatively longer.By Zakim classification,68.4% cases were hepatocellular type,10.1% cases were cholestatic type and 21.5% cases were mixed type.As the prognosis,70 cases improved,6 cases were healed,2 cases unchanged or became worse and 1 case dead.ConclusionsMany agents could induce liver injury during long-term usage.Once DILI is discovered,treating in time and rechecking liver function regularly should be performed.