93例急性药物性肝损伤的临床分析

Clinical analysis on 93 cases with acute drug-induced liver injury

目的探讨急性药物性肝损伤(DILI)的临床特征。方法回顾性分析2011年1月至2012年12月本院收治93例急性DILI患者的病因、临床表现及预后。结果多种药物可引起DILI,以中草药(40.86%)、抗结核药物(21.51%)及抗生素(12.90%)最为多见。多种给药途径引起DILI,以口服给药为主(59/93,63.44%)。患者的临床表现多为乏力(52例,55.91%)、纳差(41例,44.09%)、腹胀(21例,22.58%)、恶心及呕吐(20例,21.51%)、皮肤黄染(18例,19.35%)、腹泻(11例,11.83%)、皮肤瘙痒(10例,10.75%)、牙龈出血及鼻衄(4例,4.30%)等非特异性症状,另有部分患者(21例,22.58%)仅以肝功能异常为首发表现。本组病例分型以肝细胞损伤型最多见(61例,65.59%),其次是混合型(22例,23.66%)和胆汁淤积型(10例,10.75%)。经及时停药和保肝治疗,本组病例中治愈78例(治愈率为83.87%)、好转13例、死亡2例(病死率为2.15%)。结论临床医师应严格把握用药指征,严密监测肝功能,积极防治DILI。

Objective To evaluate the clinical characteristics of patients with acute drug-induced liver injury （DILI）. Methods The etiopathogenisis, clinical manifestation and prognosis of 93 patients with acute DILI from January 2011 to December 2012 in our hospital were analyzed retrospectively. Results Many medicines might cause liver injury, and the the main causes were the use of Chinese herbal medicines （40.86%）, antituberculosis drugs （21.51%） and antibiotics （12.90%）. Many administration routes might cause liver injury, and oral administration was the most common （63.44%）. The clinical manifestation included one or more non-specific symptoms such as debility （55.91%）, bad appetite （44.09%）, abdominal distension （22.58%）, nausea and vomiting （21.51%）, skin stained yellow （19.35%）, diarrhea （11.83%）, itch of skin （10.75%）, gingiva bleeding or epistaxis （4.30%）;but 21 patients （22.58%） showed initial abnormal hepatic function. Liver injury included hepatocellular damage type （65.59%）, mixed type （23.66%） and cholestasis type （10.75%）. Total of 78 patients （83.87%） were cured after treatment, 13 patients were improved, but 2 patients died （2.15%）. Conclusions Clinicians should control medication indication seriously and monitor liver function accurately in order to prevent and cure DILI actively.