中药与西药所致急性药物性肝损伤临床特点对比分析

Cfinical Analysis of Patients with Medicine -Induced and Traditional Medicine -Induced Liver Injury

目的探讨中药和西药所致急性药物性肝损伤的临床特点、分型和肝功能变化特点，以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标准，回顾性分析近10年来我院168例因急性药物性肝损伤住院患者的临床资料。结果168例急性药物性肝损伤患者中，联合应用中西药所致7例，中药所致者81例（占50．3％），西药所致者80例（占49．7％）。中药组女性62例（占76．5％），西药组43例（占53．8％），两组比较差异有显著性（P〈0．01）；两组的年龄构成比较无显著性差异。在161例患者中23例无明显临床表现，其中西药组有19例，明显高于中药组，两组比较差异有显著性（P〈0．01）；中药组肝细胞型、胆汁淤积型和混合型肝损伤分别有71例（87．7％）、0例和10例（12．3％），西药组分别为54例（67．5％）、2例（2．5％）和24例（30％），中药组肝细胞型所占比例高于西药组（P〈0．01），西药组混合型比例高于中药组（P〈0．01）；治疗前两组各项肝功能指标比较无显著性差异；西药组7天内发病者明显多于中药组（P〈0．01）。结论中药所致的急性药物性肝损伤在性别、临床表现、分型和发病时间上有所不同。

Objective To investigate clinical features, classifications and liver function change of traditional medicine-induced liver injury in order to improve clinical doetorshndcrstanding of this disease. Meods One hundred and sixty eight inpatients with acute drug-induced liver injury（DILD） in our hos- pital in the past ten years （2000.1-2009.12） were retrospectively investigated with the diagnosis and clas- sification method of based on international consensus meeting（ international criteria）. Results Among 168 cases, there were 81 （ 50.3 % ） and 80 cases （49.7 % ） in traditional medicine group （TMG） and medicine group（MG）, respectively. There were 62 female cases in TMG, which more than in MG （76.5% vs 53.8% ） ,P = 0. 002. There were no significant difference between two groups in age ,P = 0.29. No obvious symptoms and signs were shown in 23 cases ,among which there were 19 cases in MG,more than in TMG, P = 0. 001. In this study ,71 （87.7%） ,0 and 10（ i2.3% ） cases were designated hepatocellular, cholestet- ic and mixed DILI in TMG respectively,and 54（67.5% ） ,2（2.5% ）and 24（30% ）cases in MG,respectively. There were more hepatocellular DILl cases in TMG and more mixed DILI cases in MG, P = 0. 002 and P = 0.006. There was no significance difference between two groups on liver function before therapy. There were more cases with DILD within 7 days after using causative drug（s） in MG. Conclusion There was significance difference between TMG and MG on sex, clinical features, classifications and the time of onset.