药物性亚急性肝衰竭临床特点及预后

Clinical characteristics and prognosis of drug-induced subacute liver failure

目的分析单纯药物所导致的亚急性肝衰竭病例的临床特点及预后,以期引起临床医生的重视,并指导安全用药。方法回顾性分析本院23例药物性亚急性肝衰竭病例的用药种类、基础疾病、用药时间、临床特点、并发症及预后。结果引起亚急性肝衰竭的药物中居前3位者分别为中草药(55.0%)、抗结核药物(21.8%)和非甾体类抗炎药物(17.4%),基础疾病常见皮肤病、结核病等,临床表现与病毒性肝炎所致肝衰竭类似,肝外表现发热、皮疹发生率高,主要并发症为腹水(73.9%)、肝性脑病(60.9%)、继发肺部感染(43.5%)和腹腔感染(39.1%)。本组患者中死亡12例(55%)。死亡组的凝血酶原活动度(PTA)水平显著低于好转出院组,其并发症中肝性脑病、上消化道出血、肝肾综合征及继发感染发生率显著高于好转出院组,差异具有统计学意义(P<0.01)。结论中草药是引起药物性亚急性肝衰竭主要原因之一,应予以重视。肝性脑病,继发感染等并发症的发生及PTA持续小于20%与死亡和预后相关。

Objective To analyze the clinical characteristics and prognosis of drug-induced subacute liver failure in order to cause the clinican＇ s attention and quide safe medication. Methods Clinical characteristics of 23 patients with drug-induced subacnte liver failure in our hospital were analyzed, retrospectively, including drugs category, basic diseases, clinical characteristics, complication and prognosis. Results Among the 23 cases, the three kinds of predominant drugs induced subacute liver failure were the traditional Chinese medicine （55.0%）, antituberculotic （21.8%） and non-steroidal anti-inflammatory drugs （17.4%）. The common basic diseases were skin diseases and tubereulotic. The clinical manifestations of drug-induced subacute liver failure were not special. The incidence rate of fever, skin rash were significantly higher than that of the group of hepatic virus induced subacute liver failure. The predominant complications were hepatic encephalopathy （ 60. 9% ） , ascites （ 73.9% ） and pneumonia （ 43. 5% ）. There were 12 （52.2%） among the 23 patient were death. The incidence rate of hepatic encephalopathy, gastrointestinal bleeding, hepatorenal syndrome and secondary infection in death group were significantly higher than that in improved group （P 〈 0.01 ）. Conclusions Liver failure induced by traditional Chinese medicine should be paid more attention to. Hepatic encephalopathy, secondary infection and continuing PTA 〈 20% were relevant to the mortality and prognosis of the diseases.