药物性肝损伤143例临床分析

Clinical analysis of 143 patients with drug-induced liver injury

目的初步探讨药物性肝损伤的临床特点及其预后影响因素。方法对2013年10月至2015年10月于山西医科大学第一医院感染病科出院诊断为药物性肝损伤的143例患者的一般情况、用药史、发病时间、肝功能指标、合并的基础疾病、治疗史、预后等进行回顾性分析。结果143例患者中男49例、女94例，年龄9～76岁、平均（44±7）岁。心血管疾病用药引起的药物性肝损伤最多，26例（18．2％）；其次是皮肤病用药17例（11．9％）；甲状腺疾病用药居第3位，16例（11．2％）。服药1周～1个月发病者居多，47例（32．9％），〉1个月～3个月者31例（21．7％），12个月以上者30例（21．0％）；不同发病时间患者治疗有效率比较差异无统计学意义（x2=1．43，P〉0．05）。肝细胞损伤型在药物性肝损伤中最为常见，71例（49．7％）；其次是混合型，53例（37．1％）；胆汁淤积型最少，19例（13．3％）；不同类型肝损伤的治疗有效率比较差异无统计学意义（x2=1．42，P〉0．05）。治疗无效患者肝功能指标总胆红素及碱性磷酸酶水平明显高于治疗有效患者[（257±81）μmol／L比（814-37）μmol／L。（212±99）U／L比（1254-40）U／L]（P〈0．05）。结论药物性肝损伤主要以肝细胞型为主，总胆红素、碱性磷酸酶水平可作为判断预后的指标。

Objective To explore the clinical features of patients with drug-induced liver injury and the influence factors of prognosis. Methods Totally 143 patients diagnosed as drug-induced liver injury from October 2013 to October 2015 were enrolled, and the general information, medication history, onset time, hepatic func- tion, basic disease, treatment and prognosis were retrospectively analyzed. Results In 143 patients, there were 49 males and 94 females, the age was 9-76 years [ （ 44 -± 7 ） years 1. The drug-induced liver injury was mainly caused by cardiovascular disease medication 118.2% （26/143） ], followed by skin disease medication E 11.9% （17/143） ] and thyroid disease medication [ 11.2% （16/143） ~. The time of onset was mostly 1 week to 1 month after medication E32. 9% （47/143） 1, followed by 1-3 months after medication [21.7% （31/143） ] and more than 12 months after medication [ 21.0% （ 30/143 ） ~ ; the treatment efficiency was not significantly different among groups of different onset time （X2 = 1.43, P 〉 O. 05 ）. Liver cell injury is the most common injury type ~49. 7% （71/143） ], followed by hybrid injury E 37. 1% （53/143） ] and cholestasis injm＇y [ 13.3% （19/143） ] ; the treatment efficiency was not significantly different among groups of different injury types （X2 = 1.42, P 〉 0. 05 ）. The levels of total bilirubin and alkaline phosphatase in non-responders were significantly higher than those in patients with good treatment efficiency [ （257 ± 81 ）μmol/L vs （81 ± 37） μmol/L, （212 -99） U/L vs （125 ±40） U/L] （P 〈0.05）. Conclusion The incidence of drug-induced liver injury mainly injury type is liver cell injury; the levels of total bilirubin and alkaline phosphatase can be used as a predictive factor of prognosis.