四川省医院药物性肝损害病例分析

A Clinical Analysis of Patients With Drug-induced Liver Injury

目的探讨药物性肝损害的病因、临床特点、过敏原检测、分型、治疗效果及预后分析。方法选择四川省人民医院370例临床诊断为药物性肝损害的门诊及住院患者,对其用药史、临床表现、肝功能、过敏原检测及预后等进行回顾性分析。结果引起药物性肝病的前3位药物分别为中草药(27.30%)、抗肿瘤药物(18.92%)、抗结核药物(13.78%);临床表现非特异。肝损害以肝细胞损害型最为常见(56.76%)。过敏原IgE检测阳性率高达68.11%,高IgE提示过敏的可能性大。药物性肝损害患者的预后较好,其中治愈和好转率达85.95%。结论引起药物性肝病的药物种类繁多,由于药物性肝病临床表现无特异性,易误诊及漏诊,因此在临床工作中应重视药物性肝损害,过敏原检测有一定临床意义。

Objective To discuss the etiology, clinical characteristics, allergen detection, classification, the treatment effect and prognosis analysis of drug - induced liver injury （DILI）. Methods A total of 370 patients with DILI were reviewed retrospectively. Results Chinese herb medicine （27.30%）, antitumor agents （18.92%） and antituberculosis drugs （13.78%） were the most common drugs causing liver injury; no spe- cificity appeared in chnical manifestations of DILI patients. HepatoceUular injury was the most common type （56. 76% ） ; the positive rate of allergens IgE was as high as 68. 11%, suggesting the possibility of allergy. Patients with DILl usually had favorable prognosis; the overall cure and improvement rate was 85.95%. Con- clusion A variety kinds of drugs can cause DILI. As the clinical manifestations of DILI are different and non - specific, mis - diagnosis and missed diagnosis of DILI are made by clinicians, calling for more atten- tion to DILI in the clinical work. Allergens detection bears certain clinical significance in DIM.