药物性肝损害103例临床分析

Clinical analysis about 103 cases of drug induced liver disease

目的：探讨药物性肝损害的临床特点及其发病规律。方法：对１０３例药物性肝损害的临床资料进行回顾性分析。结果：药物性肝损害占同期“急性肝炎”住院患者的９．６％；引起肝损害的药物种类繁多，以抗结核药为最多（４５％），其次为中药（２０％）；用药２～４ｗｋ出现肝损害者最常见（６６％），２ｗｋ内者次之（２６．２％）；临床以急性肝炎肝细胞型最常见（６２．１％），其中５例出现暴发性肝功能衰竭（４．９％）；主要临床表现为疲乏、纳差、恶心、呕吐、腹胀（７１．８％），其次为黄疸（５９．２％），肝功能受损以ＡＬＴ、ＧＧＴ、ＢＩＬ增高为主；临床治愈６５例（６３．１％），好转３４例（３３％），死亡３例（２．９％）。结论：药物性肝损害的临床特点并无特异性，与病毒性肝炎相似；可引起肝损害的药物包括临床各科应用的药物，以往认为比较安全的中药，肝损害发生率逐渐增多，达２０％，值得重视。

AIM: To investigate the clinical features and nosogenesis of drug induced liver disease (DILD). METHODS: The retrospectively study on the clinical data of 103 cases of DILD was taken. RE- SULTS: The DILD account for 9.6% of in-patients with 'acute hepatitis' in the corresponding period. There were many medicines that could produced liver lesion, but antituberculous were the most (account for 45%), and followed by Chinese herbal medicines (20%); it was the commonest that produced liver lesion in the 2nd-4th wk after took medicine (66%), and in the 2nd wk next (26.2% ); acute hepatocellu- lar hepatitis was the commonest on clinic (62.1%), and 5 cases occurred fulminating hepatic failure (4.9%) among them; the fatigue, anorexia, nausea, vomiting and abdominal distension were principal clinical manifestation (71.8% ), and followed by the jaundice (59.2% ) ; ALT, GGT and BIL were higher after liver function lesion; there were 65 cases for clinical cure (63.1%), 34 cascs for improvement (33%), and 3 cases for death (2.9% ). CONCLUSION: The clinical manifestation of DILD has not speci- ficity, and is similar to virus hepatitis. The drugs that caused liver lesion include those medicines for every clinical department. The incidence rate of liver lesion caused by Chinese herbal medicines that were thought safety in the past has been increasing gradually (account to 20% ), and must be pay attention to.