药物性肝损害146例临床分析

Clinical analysis of 146 cases of drug-induced liver injury

目的:探讨药物性肝损害的病因及临床特点。方法:对2008-2013年本院的146例患者药物性肝损害进行回顾性研究,根据Maria药物性肝损害评分标准进行评价,对其所用药物、临床表现和治疗与转归等特点进行回顾性分析。结果:146例患者中,Maria评分均大于或等于10分。引起肝损害的药物种类繁多,中药占首位(26.7%),其次为抗结核药物(20.5%),抗生素为11.0%,其他药物为41.8%。临床分型,肝细胞损伤型占80.80%,胆汁淤积型占8.90%,混合型占10.30%。引起的肝损害型以轻、中度为主,临床表现主要为乏力、纳差、尿黄、恶心和右上腹不适等。患者使用还原型谷胱甘肽或还原型谷胱甘肽联合复方甘草甜素治疗,2周内可明显改善肝损害表现及恢复肝功能。146例患者中有126例治愈好转,占86.3%,而病死率为5.5%(8/146)。结论:Maria药物性肝损害国际共识标准规范了临床诊断,有助于肝损害的鉴别诊断,但其可操作性有待进一步改善。致肝损害的药物种类繁多,临床表现无特异性,但病死率较高,中草药及其制成品引发肝损害占首位,应引起临床医生重视,用药期间应注意监测肝功能。

Objective： To investigate the etiolagy of drug - induced liver injury and clinical characteristics. Methods： For 2008 -2013 count of drug-induced liver injury cases were retrospectively studied 146 cases, according to Maria drug- induced liver injury scoring criteria to evaluate drugs used in its clinical manifestations and treatment characteristics and outcome were analyzed retrospectively. Results： One hundred and forty - six cases of patients, Maria score greater than or equal to 10 marks, causing liver damage in a wide variety of drugs, traditional Chinese medicine accounted for the first （26.7%）, followed by anti -TB drugs （20. 5% ）, other antibiotics 11.0%, other drugs 41.8% . Clinical type, type of liver cell injury type was 80. 80% , cholestasis type was 8. 90% , mixed type was 10. 30%. Liver damage caused by mild to moderate levels, clinical manifestations were fatigue, anorexia, dark urine, nausea, and right upper quadrant discomfort. Use of reduced glutathione （ glutathione）, atomolan joint compound glycyrrhizin （ MMC ） treatment of acute drug - induced liver injury two weeks could significantly improve the performance of drug induced liver injury and restore liver function. 86. 3% （126/146） were cured improved and mortality was 5. 5% （8/146） . Conclusion： Maria DILI indeed regulate international consensus standard clinical diagnosis, differential diagnosis helps liver damage, but it needs to be further improved operability. Induced liver injury in a wide variety of drugs, clinical manifestations are nonspecific, but mortality is high, herbal liver damage caused by their products accounted for the first （26. 7% ）, clinicians should cause attention, clinicians should pay attention to medication monitoring of liver function.