药物性肝衰竭100例临床特征分析

Clinical features of 100 patients with drug-induced liver failure

目的探讨药物性肝衰竭(drug-induced liver failure, DILF)患者用药情况、临床特征及预后。方法回顾性分析2016年4月至2018年3月100例DILF患者的用药史、基础疾病、症状、实验室检查、并发症及预后等。结果 100例DILF患者中女性多于男性,发病平均年龄(47.5±16.7)岁,平均潜伏期82.2 d。引起DILF主要的药物包括中药汤剂、解热镇痛药、中成药,而治疗感染性疾病(结核病除外)、皮肤病、结核病的药物位居前三位。DILF的分型以亚急性(57.0%)为主,临床分型以肝细胞损伤型(63.0%)为主。急性肝衰竭较亚急性肝衰竭预后差,差异有统计学意义(P=0.023)。100例患者临床治愈11例,临床好转37例,无效44例,死亡8例。在DILF患者中,治愈或好转组的AST、 TBil、γ-谷氨酰基转移酶(GGT)、国际标准化比率(INR)、血氨(AMMO)明显低于无效或死亡组(均P<0.05),白蛋白、凝血酶原活动度(PTA)、总胆汁酸(TBA)、总胆固醇(TC)、血小板(PLT)明显高于无效或死亡组,差异有统计学意义(均P<0.05)。DILF患者出现的并发症前三位分别为胸腹水、低钠血症和感染。与预后不良相关的因素为低钠血症、感染、肝性脑病、肝肾综合征、休克、出血,差异有统计学意义(P<0.05)。结论 DILF起病急,并发症多且严重,预后不良,临床用药需加强管控并密切监测。

Objective To investigate the medication,clinical characteristics and prognosis of 100 patients with drug-induced liver failure(DILF).Methods A retrospective review of 100 patients with DILF from April 2016 to March 2018 in our hospital were performed by analyzing the drugs leading to DILF,underlying diseases,symptoms,laboratory examination results,complications and prognosis.Results In the DILF patients,the age ranged from 8 months to 84 years,the average age was 47.51±16.71 years.And there were more female patients than male.The onset time of DILI varied greatly,with an average incubation period of 82.21 days.The top 3 kinds of drugs leading to DILF were decoction of traditional Chinese medicine,antipyretic analgesics,and Chinese patent medicine.Drugs for infectious diseases(except tuberculosis),dermatosis and tuberculosis were the top 3 in patients with underlying diseases.DILF was mainly subacute(57,57.0%)according to the duration,and was mainly hepatocyte injury(63,63.0%)according to clinical classification.The prognosis of acute DILF was worse than that of subacute DILF(P=0.023).In the 100 patients,11(11.0%)were cured,37(37.0%)were improved,44(44.0%)experienced treatment failure and 8(8.0%)were dead.The levels of aspartate aminotransferase,total bilirubin,gamma-glutamyltransferase,international normalized ratio,blood ammonia in cured or improved patients were apparently lower than those in patients experienced treatment failure or dead from DILF(P<0.05),while the levels of albumin,plasma prothrombin activity,total bile acid,total cholesterol,platelet were higher(P<0.05).The top 3 complications were hydrothorax/ascites,hyponatremia and infection.Among the complications,hyponatremia,infection,hepatic encephalopathy,hepatorenal syndrome,shock and hemorrhage were associated with poor prognosis(P<0.05).Conclusion DILF is characterized by acute onset,more and serious complications,therefore,clinicians need to strengthen drug control and monitor the adverse reactions during the course of treatment.