418例药物性肝损害临床特征及预后分析

The clinical features and prognosis analysis of 418 patients with drug-induced liver injury

目的分析引起药物性肝损害的药物种类,探讨其临床特征及预后。方法回顾性总结我院近3年收治的418例药物性肝损害患者临床资料,分析其药物种类、临床表现、肝脏生化学检测、肝穿刺病理及治疗转归等相关指标。结果引起药物性肝损害前5类药物分别是中药、抗生素、解热镇痛药、抗结核药、心血管药。418例患者中急性药物性肝损害218例(占52.2%);慢性药物性肝损害112例(占26.8%);药物性肝功能衰竭81例(占19.4%);药物性肝硬化7例(占1.7%)。418例药物性肝损害患者中治愈152例(36.4%),好转206例(49.3%),无效47例(11.2%),死亡13例(3.1%)。影响预后的肝功能指标为AST、TBil、Alb、CHE、PTA。结论药物性肝损害的的致病药物种类较多,临床表现缺乏特异性,AST、TBil、Alb、CHE、PTA与预后具有明显的相关性。

Objective To investigate the etiology, clinical feature and related prognosis factors of patients with drug-induced liver injury（DILI）. Methods Four hundred and eighteen patients with DILI admitted to our hospital from February 2009 to February 2012 were retrospectively reviewed according to their drug history, clinical features, lab tests, complications and related prognosis factors. Results The etiological drugs of DILI primarily were herbal medicine, antibiotics, antipyretic analgesic, anti-tuberculosis and cardiovascular drugs. Among the 418 patients with DILl, 52.2% were acute DILl, 26. 8% were chronic DILI, 19. 4% were drug-induced liver failure, and 1. 7% were drug-induced cirrhosis, respectively. The overall cure rate was 36.4%, the improvement rate was 49.3%, the worsening rate was 11.2%, and the mortality rate was 3. 1%. The prognosis factors of DILI were levels of AST, TBil, Alb, CHE and PTA. Conclusion Various kinds of drugs could cause liver injury. Patients with DILI had specific clinical manifestation. The prognosis factors of DILl are correlated with levels of AST, TBil, Alb, CHE and PTA.