急性药物性肝损伤65例临床分析

Clinical Analysis of 65 Cases with Acute Drug-induced Liver Injury

目的:探讨急性药物性肝损伤的致病药物、临床特点及预后。方法:回顾性分析近年来本院确诊的急性药物性肝损伤患者的临床情况。结果:本组引起急性药物性肝损伤的最常见药物为抗结核药,占47.69%,其次为中草药、抗肿瘤药、滋补药、抗真菌药,分别占16.92%、9.23%、7.69%、3.61%。引起肝损伤发生时间因所用药物不同而差异较大,用药后出现药物性肝损伤的时间分别为用药2周内(36.92%)、2-4周内(32.31%)、4周-12周内(23.08%)、大于12周(7.69%),大多数病例出现于服药后12周内(92.31%)。本组急性药物性肝损伤的临床表现主要为消化道症状明显,乏力、食欲下降,占89.23%;巩膜黄染、尿黄,占43.08%;皮肤瘙痒38.46%;恶心、呕吐,占35.38%;药物性肝损伤临床分型以肝细胞损伤型多见,占61.54%,其次为胆汁淤积型(29.23%),混合型较少(9.23%)。结论:引起急性药物性肝损伤的药物种类繁多,很多临床常见的药物可引起肝损伤,早期诊断并停止用药、积极治疗是阻止疾病进展和改善预后的关键。

Objective： To explore the clinical characteristics of acute drug-induced liver injury （DILl） and the categories of drugs that induced liver injury. Methods： The retrospective analysis was performed on 65 patients of DILI in the recent years in this study. Results： Among the drugs that induced liver injury, the anti-tuberculosis drugs were on the first place in this study, accounted for 47.69%, fol- lowed by the herbal medicine, the antineoplastic agents, tonic medicine and antifungal drugs, accounted for 16.92%, 9.23%, 7.69%, 3.61% respectively. The occurring time of liver injury was significantly different, which depended on the category of drugs that induced liver injury. The time used in drug after hepatic injury： using 2 weeks of 24 cases （36.92%）; 2-4 weeks in 21 cases （32.31%）; 4 weeks to 12 weeks of 15 cases （23.08%）. More than 12 weeks in 5 patients （7.69%）. Most of the cases in medication after 12 weeks （92.31%）. The acute hepatic injury drug clinical manifestation mainly for gastrointestinal symptoms, fatigue, loss of appetite, accounted for 89.23%. Sclera jaundice, thick urine, accounted for 43.08%; skin itching 38.46%. Nausea and vomiting, accounting for 35.38%. The clinical pat- terns of injury were hepatocellular injury type （61.54%）, hepatic cholestatic type （29.23%） and the mixture （hepatocellular injury with hepatic cholestasis） type （9.23%）. Conclusion： There are various kinds of drugs, which can lead to the DILL Many clinical common drugs can cause liver injury. To prevent the progression and improve the prognosis of DILI is to diagnose and stop taking the drugs earlier.