静脉用胺碘酮引起急性肝损害患者原因及其临床特点分析

Clinical features of amiodarone-induced acute liver injury

目的探讨并分析静脉应用胺碘酮引起急性肝损害患者的临床特点及其可能的原因。方法 2010年2月~2016年2月期间我院心内科及部分其它科室在静脉注射胺碘酮后出现急性肝功能损伤患者23例,分析患者的基础疾病、用药方法、合并用药情况、发现肝损害的时间、肝功能恢复时间以及转归等特点。结果在静脉注射胺碘酮后,2例(8.7%)患者在8 h内即表现出肝功能损害,8例(34.8%)患者在9~48 h之间出现,5例(21.7%)患者在49~72 h间出现,7例(30.4%)在73~96 h间出现,1例(4.3%)患者在96 h后出现;谷草转氨酶峰值达17468 U/L,平均值为(3648±3889)U/L,谷丙转氨酶峰值达13437 U/L,平均为(3142±1846)U/L,15例(65.2%)患者出现黄疸;出现肝损害后立即停用胺碘酮并给予积极治疗,19例患者肝功能在2~91 d恢复正常,平均时间为(33.76±19.38)d;1例患者因心源性休克死亡,2例患者因急性肝肾功能不全死亡,1例患者因肝性脑病死亡。结论胺碘酮致使肝功能损害的具体机制尚未明确,无法完全排除其它药物对肝功能的影响,但胺碘酮是引起肝功能损害的重要因素。

Objective To summarize the clinical characteristics of amiodarone-induced acute liver injury. Method 23 patients with acute liver injury after intravenous administration of amiodarone were selected in our hospital between February 2010 and February 2016. The underlying diseases,medical regimen,the use of amiodarone indications,combined medication,the time of liver damage,liver function recovery and outcome were recorded. Results After intravenous administration of amiodarone,2 cases （8.7%） showed liver damage in 8 h,8 cases （34.8%） hade liver damage between 9-48 h,5 cases （8.7%） with 49-72 h,7 cases （30.4%） in 73-96 h, 1 cases （4.3%） after 96 h;serum aspertate aminotransferase levels peaked up at 17468 U/L,with average of （3648±3889） U/L,alanine aminotransferase peaked up at 13437 U/L,with average of （3142±1846） U/L,and 15 cases （63.2%） had jaundice;19 patients recovered with liver function back to normal within 2-91 days,and the average time was （33.76±19.38） days after withdrawal of amiodarone and having an active treatment,1 patients died of cardiac shock,2 patients died of acute liver and kidney insufficiency and 1 patients died of hepatic encephalopathy. Conclusion The specific mechanism of liver damage by amiodarone is not yet clear,and we can not completely eliminate the effect of other medications on the liver function abnormal,but there is no doubt that amiodarone is an important factor causing liver damage.