202例药物性肝损伤临床特征回顾性分析

Retrospective Analysis of Clinical Features of 202 Patients with Drug-induced Liver Injury

目的:分析药物性肝损伤(DILI)的病例特点,为其早期发现和临床诊断提供相关依据。方法:采用回顾性分析方法,收集某医院2016~2019年收治的202例DILI病例,统计患者年龄、性别、基础疾病、可疑药物、DILI分型分级与临床表现,以及肝生化指标[ALT、AST、AKP、总胆红素(TBIL)、γ-谷氨酰转肽酶]、国际标准化比值(INR)等指标。将病例分别按临床分型、急慢性和严重程度,以及不同可疑药物进行分组,对比各组患者各项指标的差异性。结果:202例DILI患者中男63例,女139例,40岁以上患者138例;患者中14例有药物过敏史,37例合并其他类型肝脏疾病;平均住院疗程为(16.35±9.77)d。4年来DILI患者例数与占比逐年上升;可疑药物主要为中药、抗肿瘤药和抗菌药物;病例临床表现无明显特异性。临床分型以肝细胞损伤型为主,共152例;急性肝损伤多见,有159例。肝细胞型与胆汁淤积型患者的主要肝生化指标差异显著(P<0.05),肝细胞型与混合型患者的AKP水平差异显著(P<0.05)。三种临床分型的严重程度无明显差异;慢性DILI患者的AKP、TBIL和γ-谷氨酰转肽酶水平高于急性DILI患者(P<0.05);有其他肝脏基础疾病患者的主要肝生化指标明显高于无肝脏基础疾病的患者(P<0.05)。中药导致的DILI的严重程度重于西药(P<0.05)。结论:DILI临床表现无明显特异性,中药和抗肿瘤药为主要致病药物,临床应引起重视,及时发现DILI并尽早治疗。

Objective:To analyze and discuss the case characteristics of drug-induced liver injury(DILI),so as to provide relevant basis for the early detection and clinical diagnosis.Methods:A retrospective analysis was conducted to collect 202 cases of drug-induced liver injury admitted between 2016 and 2019 in certain hospital.Statistics of the patient’s age, sex, clinical manifestations, basic diseases, suspicious drugs, and the changes of ALT, AST, AKP, total bilirubin(TBIL) and international standardization ratio(INR), etc. Cases were grouped according to clinical type, acute and chronic, severity and suspicious drugs. The differences of each index in each group were compared. Results:Among the 202 patients with DILI, 63 were male, 139 were female, and 138 were over 40 years old. Among the patients, 14 had a history of drug allergy and 37 had other types of liver diseases. The average length of hospital stay was(16.35±9.77) d. In the past 4 years, the number and proportion of patients with DILI increased year by year. The suspected drugs were mainly traditional Chinese medicine, anti-tumor drugs and antibacterial drugs. The clinical manifestations showed no obvious specificity. The clinical types were mainly hepatocyte injury(152 cases), and acute liver injury was more common(159 cases).The differences of main hepatic biochemical indexes between hepatocyte type and cholestatic type were significant(P<0.05). AKP was significantly different between hepatocyte type and mixed type(P<0.05). There was no significant difference in the severity of the three clinical types. AKP, TBIL and γ-glutamyl transpeptidase in chronic DILI were higher than those in acute DILI(P<0.05). The main hepatic biochemical indexes were higher in patients with other liver diseases than in those without other liver diseases(P<0.05). DILI induced by traditional Chinese medicine was more severe than DILI induced by western medicine(P<0.05). Conclusion:The clinical manifestations of drug-induced liver injury have no obvious specificity. Traditional Chinese medicine and anti-tumor drugs are the main pathogenic drugs, so clinical attention should be paid to timely detection of DILI and early treatment.