236例药物性肝损伤的分析

Clinical analysis of 263 cases of drug induced liver injury

目的探讨药物性肝损伤(DILI)的特点和发生规律,为该病的预防与临床用药提供参考。方法对2014年1月~2017年12月我院诊断DILI全部患者的临床资料进行回顾性分析。结果全部376例诊断为DILI的病例,使用RUCAM量表筛选出236例。236例中,0~19岁3例(1.27%),20~39岁35例(14.83%),40~59岁111例(47.03%),60~79岁70例(29.66%),80岁以上17例(7.20%)。起病前涉及药物摄入时间的中位数为20 d。涉及的药物以抗肿瘤药(30.08%)为最多,其次为抗感染药物(29.66%)、传统中药(10.59%)。结论导致DILI最常见的药物是抗肿瘤药、抗感染药物、传统中药。DILI的临床表现缺乏特异性,要重视实验室检查辅助诊断,开展个体化的药学监护,重视药物的不良反应和监测。同时也要重视大数据库的临床应用。

Objective To explore the clinical features and regular patterns of drug induced liver injury（DILI） in order to provide reference for DILI prevention and clinical medication.Methods All cases of drug induced liver injury from January 2014 to December 2017 were analyzed retrospectively.Results A total of 236 cases were chosen from 376 cases of DILI by the Roussel Uclaf Causality Assessment Method（RUCAM）.Of 236 cases,there were 3 cases（1.27%） happened in 0-19 years old,35 cases（14.83%） happened in 20-39 years old,111 cases（47.03%） happened in 40-59 years old,70 cases（29.66%） happened in 60-79 years old,and 17 cases（7.20%） happened over 80 years old.The median of intake duration of the involving drugs was 20 days.Most of the involving drugs were anti-tumor drugs（30.08%）,anti-infective drugs（29.66%） and traditional Chinese medicine（10.59%）.Conclusions The most common drugs induced DILI are anti-tumor drugs,anti-infective drugs and traditional Chinese medicine.Clinical manifestations of DILI are deficient in specificity.It is important that the diagnosis and treatment procedures of DILI need laboratory examination,individualized pharmaceutical care,adverse drug reactions and monitoring.And it also should be payed more attention on the clinical application of large databases.