168例药物性肝损伤的临床特点分析

C1inical Analysis of 168 Patients with Drug-Induced Hepatic lnjury

目的探讨急性药物性肝损伤的病因、临床特点、分型及预后,从而提高临床医师对该病的认识。方法采用急性药物性肝损伤诊断及分类国际共识标准,回顾性分析近10年来首都医科大学附属北京友谊医院168例因急性药物性肝损伤住院患者的临床资料。结果本研究中有147例肝损伤发生在用药的3～90d内;有25例患者无明显临床症状体征,在有临床表现的患者中乏力最多见,占50%。引起肝功能损伤的药物种类较多,最常见的为中药,占48.2%,其次是抗生素和消化系统用药,分别占10.1%和9.5%。肝细胞型、胆汁淤积型和混合型肝损伤者分别占77.9%、7.8%和14.3%。69.6%患者转氨酶于60d内降至正常上限的2倍以内。结论急性药物性肝损伤的致病原因较多,临床表现缺乏特异性,临床医师在临床工作中应提高对该病的重视。

Objective To investigate causes,clinical features,classifications and prognosis of drug-induced liver injury（DILI）in order to improve clinical doctors＇understanding of this problem.Methods 168 inpatients with acute drug-induced liver injury in our hospital in the past ten years were retrospectively investigated with the diagnosis and classification method of acute DILI based on international consensusmeeting（international criteria）.Results There were 147 cases having DILI during 3～90 days after uusing causative drug（s）.No obvious symptoms and signs were shown in 25 cases.Fatigue was the most common symptom,account for 50%.The most common drugs inducing DILI were Chinese traditional and herbal drugs,antibiotics,and drugs using in digestive system diseases.In this study,131（77.9%）,13（7.8%）,24（14.3%）cases were designated hepatocelhlar,cholestetic and mixed DILI,respectively。Most of thecases（69.6%）recovered in 60 days after withdrawal of the causative drug（s）and giving proper supportive therapy.Conclusion Many drugs could cause liver injury.The symptoms of acute DILI are unspecific.Doctors should attach much importance to DILI.