90例药物性肝病的临床特征分析

A Clinical Analysis of 90 Patients with Drug-induced Liver Disease

目的:分析药物性肝病患者的临床特征。方法:对按国内现行通用诊断标准诊断为药物性肝病的90例住院患者的临床资料进行回顾分析,并根据1997年Maria药物性肝病评分系统作重新评价。结果:引起药物性肝病的药物主要为:中药38.9%(35/90)、抗微生物药物17.8%(16/90)、非甾体类消炎药10.0%(9/90)。潜伏期3个月以内者占75.8%。主要症状包括:黄疸51.1%(46/90),纳差45.6%(41/90),乏力44.4%(40/90)。临床分型为:肝脏检查异常6.7%(6/90);肝损伤93.3%(84/90),包括肝细胞损伤型37.8%(34/90),胆汁淤积型36.7%(33/90),混合型18.9%(17/90)。按照Maria评分标准进行再评估,确定为药物性肝病者0例,可能性大者4例(4.4%),有可能者19例(21.1%),可能性小者54例(60%),可除外药物性肝病者13例(14.4%)。结论:药物性肝病临床表现无特异性,诊断标准不统一,临床医师应提高对本病的认识和诊断意识,避免漏诊和误诊。

Objective：To analyze the features of drug-induced liver disease（DILD）.Methods： Ninety DILD patients admitted to our hospital from Jan 2006 to Jun 2009 were reviewed retrospectively and reevaluated by Maria＇s diagnostic scale.Results： The major agents causing DILD included herbal medicine 38.9%（35/90）,antimicrobial agents 17.8%（16/90） and nonsteroidal anti-inflammatory drugs 10.0%（9/90）.75.8% patients had latent period less than 3 months.Main symptoms included jaundice 51.1%（46/90）,anorexia 45.6%（41/90）,and fatigue 44.4%（40/90）.6.7%（6/90） were classified as abnormality of liver tests and 93.3%（84/90） as liver injury [hepatocellular type 37.8%（34/90）,cholestatic type 36.7%（33/90）,and mixed type 18.9%（17/90）].With Maria＇s diagnostic scale,no one was a definite drug-induced liver injury,4 cases（4.4%） were probable,19 cases（21.1%） were possible,54 cases（60.0%） were unlikely,and 13 cases（14.4%） could be excluded.Conclusions： Clinicians should raise the awareness and understanding of the DILD in order to avoid misdiagnosis and missed diagnosis due to the non-specific clinical manifestations and lack of uniform diagnostic standard.