198例药物性肝损伤临床分析

Clinical analysis of 198 patients with drug-induced liver injure

目的分析该院近年来导致药物性肝损伤的常见药物种类、药物性肝损伤的临床特点、诊断及预后,提高临床医生对本病的认识,指导临床合理用药。方法根据Danan标准RUCAM简化评分系统对2002年4月—2012年4月间临床诊断为药物性肝损伤而入住该院的198例病例进行回顾性分析,采用SPSS 17.0软件将数据进行χ^2检验,P〈0.05为差异有统计学意义。结果 198例患者中,引起肝损伤的药物主要为中草药、抗结核药、抗肿瘤药、抗生素等,共占62.12%,男性97例（48.99%）,女性101例（51.01%）;年龄3-88岁,中位年龄47岁;第一次服药至发生肝损伤的潜伏期在4-180 d,中位时间26 d;肝细胞损伤型124例（62.63%）,胆汁淤积型35例（17.68%）,混合型39例（19.69%）;38例无明显临床症状或体征,仅有实验室检查异常（19.19%）,而有临床症状160例（80.81%）,主要表现为乏力（65.66%）、纳差（52.02%）、眼黄尿黄（44.95%）;经治疗后痊愈59例（29.80%）,好转108例（54.55%）,自动出院28例（14.14%）,死亡3例（1.52%）,预后较好。结论该院198例药物性肝损伤主要临床类型为肝细胞损伤型,临床特点与各类型急、慢性肝脏疾病相似,并无特异性,预后好。

Objective To analyze pathogenesis,clinical features,diagnosis and prognosis of drug-induced liver injure in recent years in order to improve clinical doctors＇ awareness of this problem. Methods We scored 198 patients with drug-induced liver injure admitted to Yixian Hospital from April 2002 to April 2012 according to Danan diagnostic criteria（RUCAM simplified scoring system）. These cases were analyzed retrospectively and with SPSS 17. 0 software by χ^2-test. There existed statistical heterogeneity when P〈0. 05. Results Of the 198 cases,the major drugs that caused DILI were Chinese medicinal herbs,antitubercular drug,antineoplastic drug and antibiotics,which accounted for 62. 12% of all. There were 97 male cases（48. 99%） and 101 female cases（51. 01%）. The youngest patient was 3 years old while the oldest was 88 years old,median age being 47. The period between the time of taking medicine and the time of occurrence of DILI was 4 days to 180 days,median time to the progression being 26d. Of all the cases there were 124 hepatocellular injury（62. 63%）,35 cholestasis（17. 68%）,and 39 mixed type（19. 69%）. There were 38 patients（19. 19%） with no clinical symptom or objective sign but abnormal lab findings,while the other 160 patients（80. 81%） had clinical symptoms including fatigue（65.66%）,anorexia（54. 55%）,and colored sclera or urine（44. 95%）. After appropriate treatment,59 patients（29. 80%） were cured,108 patients（54. 55%） were improved,28 patients（14. 14%） left hospital without cure,and 3 patients（1. 52%） died. Conclusions The main damage type in the 198 cases of DILI is hepatic cellular injury,clinical feature of which is similar to each acute or chronic liver disease. It has no specificity,and the prognosis is good.