慢性药物性肝损伤33例临床特点分析

Clinical characteristics of 33 patients with drug induced chronic liver injury

目的了解慢性药物性肝损伤临床特点。方法回顾性分析2001年4月至2010年8月北京大学第一医院感染疾病科随访的33例慢性药物性肝损伤患者临床特点。结果 33例患者平均年龄(40±15)岁;女性22例(66.7%)。27例(82%)起病时肝损伤为肝细胞型,淤胆型和混合型少见,分别为2例(6%)和4例(12%)。27例肝细胞型肝损伤中,23例(85.2%)起病时类似急性黄疸型肝炎;14例(51.8%)病理显示慢性肝炎。所有患者,12例(36.4%)治愈;3例(9%)发展为肝硬化,平均病程32个月;2例(6%)死亡。涉及药物,中药所占比例最高42.9%,依次为抗生素31%,心血管药物11.9%。结论慢性药物性肝损伤女性多见,多数有类似急性黄疸型肝炎的起病过程。部分可以治愈,少部分可发展为肝硬化。中药是引起慢性药物肝损伤的重要原因之一。

Objective To investigate clinical characteristics of drug induced chronic liver injury （DICLI）. Methods A retrospective study was conducted to analyze medical records of 33 DICLI patients who had been treated in our institute from April 2001 to August 2010. DICLI was defined as a persistent biochemical abnormality for more than 6 months after drug withdrawal. Results The mean age of the 33 patients was （40 ＋ 15 ） years. There were 22 females （66. 7 % ）. Of the 33 patients at the onset of liver damage,27 （82%） showed hepatocellular type of injury ,2 （6%）showed eholestatic type and 4 （ 12% ） showed mixed type. Among the 27 cases of hepatoeellular injury,23 （85.2%） resembled acute icteric hepatitis at the onset of liver damage,and 14 （51.8%） showed pathological changes of chronic hepatitis. Of the 33 patients, 12 （ 36. 4% ） were eventually healed, 3 （9%） developed cirrhosis after a mean disease course of 32 months,and 2 （6%） died. Herbal medications contributed to 42. 9% of the DICLI cases,followed by antibiotics （31%） and cardiovascular drugs （ 11.9% ）. Conclusion DICI is more common in females than in males. Most DICLI patients have a similar onset of acute icteric hepatitis. Some DICLI patients can be cured while some may progress to cirrhosis. Herbal medications may be a major cause of DICLI.