93例药物性肝损伤患者临床特征分析

Clinical Characteristics of 93 Patients with Drug-Induced Liver Injury

目的探讨药物性肝损伤(DILI)的临床特征,提高DILI临床分型的诊断率和治疗效果。方法回顾性分析医院2014年1月至2018年12月确诊的93例DILI患者的住院资料,依据2015年版《药物性肝损伤诊治指南》分析不同DILI临床分型的特点。结果 93例DILI患者中,男25例(26.88%),女68例(73.12%);肝细胞损伤型71例(76.34%),混合型16例(17.20%),胆汁淤积型6例(6.45%);因果关系评估法量表评分≥6分的72例(77.42%),<6分的21例(22.58%);引起DILI的药物种类最多的为中药材、中药饮片和中成药(41例,44.09%),其次为抗肿瘤药物(31例,33.33%)。不同临床分型中,药物种类、严重程度分级比较,差异均有统计学意义(χ^(2)=4.468,7.191,P=0.035,0.027);肝细胞损伤型患者丙氨酸氨基转移酶、天门冬氨酸氨基转移酶初始值及峰值均显著高于胆汁淤积型和混合型(P<0.05),而胆汁淤积型患者碱性磷酸酶初始值和峰值均显著高于肝细胞损伤型和混合型(P<0.05)。结论药物种类、严重程度分级及部分生化指标水平均可影响DILI的临床分型。

Objective To investigate the clinical characteristics of drug-induced liver injury(DILI),and to improve the diagnostic rate and treatment of DILI clinical types.Methods The clinical data of 93 DILI patients diagnosed in our hospital from January 2014 to December 2018 were retrospectively analyzed.According to the Guidelines for the Management of Drug-Induced Liver Injury(2015 Edition),t he characteristics of different clinical types of DILI were analyzed.Results Among 93 DILI patients,there were 25 males(26.88%)and 68 females(73.12%).There were 71 cases(76.34%)of hepatocyte injury type,16 cases(17.20%)of mixed type and 6 cases(6.45%)of cholestasis type,72(77.42%)cases of RUCAM score≥6 points and 21(22.58%)cases of RUCAM score<6 points.The most common drug causing DILI was Chinese herbad medicine,Chinese herbal pieces and Chinese patent medicine(41 cases,44.09%),followed by anti-tumor drugs(31 cases,33.33%).The comparison of drug types and severity grades in different clinical types was statistically significant(χ^(2)=4.468,7.191,P=0.035,0.027).The initial value and peak value of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in patients with hepatocyte injury type were significantly higher than those in patients with cholestasis type and mixed type(P<0.05),while the initial value and peak value of alkaline phosphatase(ALP)in patients with cholestasis type were significantly higher than those in patients with hepatocyte injury type and mixed type(P<0.05).Conclusion Drug types,severity grades and some biochemical indexes can affect the clinical typing of DILI.