不同种类药物所致药物性肝损伤临床特点研究

Clinical Features of Drug-induced Liver Injury Caused by Different Types of Drugs

目的探讨不同种类药物所致药物性肝损伤(drug-induced liver injury,DILI)的临床特征,为临床及早诊治提供依据。方法收集我院2013年1月—2017年1月收治的DILI住院患者406例,按导致肝损伤的药物分为西药组186例(其中抗结核药物86例)、中药组157例和混合用药组63例。观察比较3组入院时及治疗2周后肝脏生化指标[丙氨酸转氨酶(ALT)、天冬酸转氨酶(AST)、γ-谷氨酰转移酶(γ-GGT)、总胆红素(TBIL)、碱性磷酸酶(ALP)],临床症状、临床分型、肝损伤严重程度及临床疗效。结果西药组患者性别比例、中位年龄与中药组和混合用药组比较差异有统计学意义(P<0.05或P<0.01);西药组入院时及治疗2周时ALT、AST、TBIL、γ-GGT水平均低于中药组和混合用药组,差异有统计学意义(P<0.05或P<0.01)。中药组和混合用药组尿黄发生率分别为58.0%和61.9%,显著高于西药组的37.1%,差异有统计学意义(P<0.01)。西药组肝损伤严重程度分级≤2级者比例高于中药组和混合用药组,≥3级者比例低于中药组和混合用药组,差异均有统计学意义(P<0.01)。3组患者临床分型、临床疗效比较差异无统计学意义(P> 0.05)。结论中药与西药导致的肝损伤患者在年龄、性别、血清生化指标、肝损伤严重程度和临床表现上有所不同,中药和混合用药导致的肝损伤要重于单纯西药导致的肝损伤;研究不同种类药物导致肝损伤的特点对于确定肝损伤药物、及早停药、阻止慢性肝炎的发生有一定意义。

Objective To investigate the clinical features of drug-induced liver injury(DILI)caused by different types of drugs,and to provide a reference for early diagnosis and treatment of this disease.Methods A total of 406 patients with DILI who were hospitalized in our hospital from January 2013 to January 2017 were enrolled in this study.According to the drugs that caused liver injury,they were divided into western medicine group,(n=186,including 86 anti-tuberculosis drugs),traditional Chinese medicine group(TCM group,n=157)and mixed medicine group(n=63).Biochemical parameters of the liver[alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyltransferase(γ-GGT),total bilirubin(TBIL),alkaline phosphatase(ALP)],clinical symptoms,clinical classification,severity of liver injury and clinical efficacy in the three groups were observed and analyzed at admission and two weeks after treatment.Results There were significant differences between western medicine group and TCM group/mixed medicine group in the proportion of female patients and the median age,The levels of ALT,AST,TBIL andγ-GGT in the western medicine group were lower than those in the TCM group and the mixed medicine group at admission and 2 weeks after treatment(P<0.05 or P<0.01).The clinical manifestations of DILI were similar to those of other hepatitis,and were characterized by poor appetite,fatigue and yellow urine.There were significant differences between western medicine group and TCM group/mixed medicine group in the proportion of yellow urine(37.1%vs 58.0%and 61.9%,P<0.01).The proportion of liver injury severity grade≤2 in western medicine group was higher but the proportion of≥3 grade was lower,as compared with that of TCM group and mixed medicine group(P<0.01).There was no significant difference in clinical classification and clinical efficacy between the three groups(P>0.05).Conclusion There were significant differences between western medicine group and TCM group/mixed medicine group in age,sex,serum biochemical indexes and severity of liver injury and clinical manifestations.The damage to liver function caused by TCM and mixture medicine is more serious than that of Western medicine alone.Therefore,to study the characteristics of liver damage caused by different kinds of drugs have certain significance in determining the drugs for liver injury,withdrawing the drugs early,and preventing the occurrence of chronic hepatitis.