药物性肝损伤住院患者临床特点回顾性分析

Retrospective Analysis of Clinical Characteristics of Hospitalized Patients with Drug-induced Liver Injury

目的了解药物性肝损伤(DILI)住院患者临床特点,为临床防治DILI提供参考。方法回顾性分析某院近5年DILI住院患者病历资料,分析患者年龄、性别、引起DILI的药物、临床表现、实验室检查、保肝药物使用等信息。结果72例患者以女性和40岁以上人群最多,汉族占88.89%。引起DILI前3位药物分别为中药28例(38.89%),抗肿瘤药物26例(36.11%),抗菌药物3例(4.17%)。给药途径以口服为主(59.72%)。患者从用药至发病时间中位数10 d。临床表现以纳差、乏力、皮肤及巩膜黄染、厌油腻、恶心常见。肝功能检查以丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)升高最为明显。最常见的DILI类型是肝细胞损伤型,肝损伤程度1级占比最高(54.17%)。保肝药物以两联以上联合使用为主。DILI患者治愈、好转和有效者共占48.61%。结论引起DILI药物种类较多,临床表现缺乏特异性。应进一步提高对DILI临床特点的认识,促进临床合理用药。

Objective To understand the inpatient clinical characteristics of drug-induced liver injury(DILI)in a hospital and to provide reference for the clinical prevention and treatment of DILI.Methods The medical records of DILI inpatients in a hospital in recent 5 years were retrospectively analyzed,including age,laboratory examination,use of hepatoprotective drugs,and other information.Results The majority of the 72 patients were female and over 40 years old with the Han nationality accounting for 88.89%.The top three drugs causing DILI were divided into 28 cases of traditional Chinese medicine(38.89%),26 cases of anti-tumor drugs(36.11%),and 3 cases of antibacterial drugs(4.17%).The main route of administration was oral administration(59.72%),and the median time from medication to onset was 10 days.The clinical manifestations were poor appetite,weakness,skin sclera yellow dye,greasy,and nausea.In liver function examination,the most obvious change was the elevation of ALT and AST.The most common DILI type was hepatocyte injury type and the highest proportion of grade 1 was hepatic injury(54.17%).Liver protecting drugs were mainly used in two or more combinations.Most patients with DILI had a better prognosis and 48.61%were cured,improved and effective.Conclusion DILI is caused by a variety of drug and its clinical manifestations is lack of specificity.More attention should be paid to DILI and its clinical characteristics to promote rational drug use in clinic.