急性药物性肝损伤临床特点及预后分析

Clinical features and the prognosis of acute drug-induced liver injury

目的:分析急性药物性肝损伤的临床特点和影响预后的因素,以进一步提高临床医生对本病的认识。方法:收集新疆石河子大学第一附属医院2010年1月至2012年12月76例急性药物性肝损伤住院患者资料,对所用药物、既往病史、实验室检查结果、临床转归进行回顾性统计和分析。结果:引起急性药物性肝损伤常见三类药物依次为抗生素(42.1%)、中草药(23.7%)和感冒药(10.5%)。急性药物性肝损伤的临床类型以肝细胞型多见(51.3%),混合型次之(28.9%),胆汁淤积型相对较少(19.7%),其中,肝细胞型和混合型的重症肝损伤发生率差异有显著性(P=0.020),而肝细胞型和胆汁淤积型及混合型和胆汁淤积型的重症肝损伤发生率差异无显著性(P=0.084和P=0.516)。此外,有慢性基础病的急性药物性肝损伤患者与无慢性基础病患者相比,其短期预后不良的发生率增加(P=0.001)。结论:国内外各地区引起药物性肝损伤的药物谱并不一致。混合型药物性肝损伤较易发展为重症肝损伤。慢性基础疾病是影响药物性肝损伤患者短期临床预后的因素之一。

Objective To analyze the clinical features and the factors affecting the prognosis of drug- induced liver injury （DILI）. Methods Clinical data of 76 DILI patients who were treated at the First Affiliated Hospital of Shihezi University from January 2010 to December 2012 were retrospectively analyzed. The patients＇ clinical manifestations, clinical and laboratory test data, drugs used and clinical .outcomes were collected and assessed. Results Within our patient population, the leading causes of DILl were antibiotics （accounting for 42.1% of cases）, Chinese herb medicine （23.7%）, and cold medications （10.5%）. The hepatoeellular injury （51.3%） was the most common type of DILl, which was followed by mixed type （28.9%） and eholestatic type （19.7%）. The incidence of severe liver injury was significantly different between the hepatocellular injury type and mixed type （P = 0.020）, but no significant differences of the incidence of severe liver injury between hepatoeellular injury type and cholestatic type, and between mixed type and eholestatie type were observed （P = 0.084, P = 0.516）. The incidence of short-term poor prognosis in DILI patients with chronic underlying diseases was significantly higher than that in DILl patients without chronic underlying diseases （P = 0.001 ）. Conclusion The mixed type of DILl was more likely to develop into severe liver injury. And chronic underlying disease was one of the factors affecting the short- term poor prognosis of patients with DILl.