368例药物性肝损伤患者临床特点分析

Clinical Characteristics of Drug-induced Liver Injury of 368 Cases

目的分析药物性肝损伤(drug-induced liver injury,DILI)的临床特点,对DILI的治疗、预后进行探讨和总结。方法收集2013年1月至2017年12月宁夏医科大学总医院诊断DILI的一般资料、导致肝损伤的相关药物、临床表现、实验室指标变化、相关治疗药物、预后等指标并进行统计学分析。结果 DILI多集中在40~70岁人群,其中女性(227例)患者多于男性(141例)。近5年DILI发病人数呈增长趋势。引起DILI的药物包括中药等24类药物,其中,中药类占比例最高(31.75%),用药方式以口服常见。DILI起病方式以黄疸、消化道症状多见。DILI以肝细胞损伤型最为多见,肝细胞损伤型、胆汁淤积型及混合型3种分型间平均发病年龄、ALT、AST、ALP、GGT、TBIL、DBIL、ALB、GLB、PT、PTA水平比较差异均有统计学意义(P均<0.05)。本研究中DILI治疗药物主要以门冬氨酸鸟氨酸、复方甘草酸苷为主,18例患者治疗过程中出现预后较差,余经治疗后均好转出院;预后不良组与预后良好组其ALT、AST、CHE、ALB、PLT、PTA、APTT、INR水平差异比较差异均有统计学意义(P均<0.05)。不同的临床分型其预后差异无统计学意义(P=0.082);中、西药导致的DILI其预后差异亦无统计学意义(P>0.05)。结论 DILI以中老年女性为主,导致DILI的药物种类多样,以中药为主,口服药居多。临床表现以黄疸及消化道症状为主,临床分型以肝细胞损伤型为主,肝细胞损伤型其ALT、AST水平更高,而胆汁淤积型其GGT、ALP、TBIL、DBIL水平更高。DILI患者总体预后大多良好,但发病人数呈逐年增高趋势。

Objective To analyze the clinical features of drug-induced liver injury(DILI),and to discuss and summarize the treatment,prognosis of DILI.Methods The general data of DILI diagnosis,related drugs,clinical manifestations,laboratory indicators,related therapeutic drugs and prognosis were collected from the General Hospital of Ningxia Medical University from January 2013 to December 2017 and analyzed statistically.Results DILI was concentrated in the 40~70 age group,with more women (227 cases) than men (141 cases).The number of cases of drug-induced liver injury has increased in the past five years.The drugs caused DILI that included 24 kinds of drugs such as traditional Chinese medicines,among which traditional Chinese medicines accounted for the highest proportion(31.75%),and oral administration were the most common.The DILI onset was mostly non-specific,mainly due to jaundice and gastrointestinal symptoms.The most common type of DILI was hepatocyte injury.There were significant differences in the levels of ALT,AST,ALP,GGT,TBIL,DBIL,ALB,GLB,PT,PTA and mean age of onset among hepatocyte injury type,cholestasis type and mixed type (P<0.05).In this study,DILI treatments mainly consisted of aspartate ornithine and compound glycyrrhizin.Total 18 patients had a poor prognosis during treatment,and the remaining patients were discharged after treatment.There were significant differences in the levels of ALT,AST,CHE,ALB,PLT,PTA,APTT and INR between the poor prognosis group and the prognosis group(P<0.05).There was no significant difference in the prognosis of different clinical classifications(P>0.05).There was no significant difference in the prognosis of drug-induced liver injury caused by Chinese and Western medicine(P>0.05).Conclusion DILI is dominated by middle-aged and elderly women,resulting in a variety of DILI drugs,mainly traditional Chinese medicine,oral medicine.The main clinical manifestations were jaundice and digestive tract symptoms.The main clinical types were hepatocyte injury.The levels of ALT and AST in hepatocyte injury were higher than those in cholestasis.The levels of GGT,ALP,TBIL and DBIL in cholestasis were higher.The overall prognosis of DILI patients is good,but the incidence of DILI is increasing year by year.