68例药物性肝损害病因和临床特征分析

68 cases analysis of the etiology and clinical characteristics of drug-induced liver

目的提高对药物性肝损伤的认识,及早做出正确诊断和治疗,减少各种严重药物性肝损伤以及并发症的发生。方法对我院2002～2009年间68例药物性损伤住院患者进行病因及临床特点(基础疾病史、服药史、临床表现、血常规、肝功能,观察治疗效果)的回顾性分析,并探讨其发生的可能机制。结果解热镇痛抗炎药物引起药物性肝病占据较大的比例,占统计患者的51.24%。主要表现为乏力、上腹部不适和恶心,皮肤巩膜的黄染、皮疹、肝肿大,有50%的患者无任何自觉临床症状。以肝细胞损伤为主42例(61.76%)。实验室检查均有不同程度的肝功能损伤,以ALT为主,表现为100%,其次为GGT检查异常61例(89.71%)。结论药物性肝病关键在于预防,应用相关药物治疗期间应注意监测药物的各种毒副作用,患者一旦出现临床的症状和(或)体征以及肝功能异常,应立即停止药物治疗;酌情适当给予应用护肝药物、支持疗法等,一般预后良好。

Objective To raise the awareness of drug-induced liver injury,early and make the correct diagnosis and treatment,reduction of a variety of serious drug-induced liver damage and complications.Methods In our hospital from 2002 to 2009,a retrospective analysis among 68 cases of hospitalized patients with drug-induced injury to etiology and clinical characteristics （underlying disease history,medication history,clinical manifestations,blood,liver function,observed treatment effects）,and to explore its place possible mechanism.Results Antipyretic analgesic anti-inflammatory drug-induced liver disease account for a large proportion,accounting for 51.24% of cases.Mainly manifested as fatigue,upper abdominal discomfort and nausea,skin stained yellow sclera,skin rash,hepatomegaly,50% of cases without any clinical symptoms and consciously.Of liver cell injury,accounting for 61.76%（42/68）.Laboratory tests have varying degrees of liver impairment in order to ALT mainly expressed as the ratio of 100%,followed by examination of GGT abnormalities 61 cases（89.71%）.Conclusion Drug-induced liver disease lies in prevention,application-related drugs,monitoring during treatment should pay attention to a variety of toxic side effects of drugs,the patient once the clinical symptoms and （or） signs,and abnormal liver function,should immediately stop drug therapy,where appropriate,to give the appropriate application of liver drugs,supportive therapy,are generally a good prognosis.