丙氨酸转氨酶显著升高的药物性肝损伤的临床特点分析

ANALYSIS OF CLINICAL CHARACTERISTICS OF PATIENTS IN DRUG-INDUCED LIVER INJURY WITH SIGNIFICANTLY INCREASED ALANINE AMINOTRANSFERASE

目的研究丙氨酸转氨酶(ALT)明显增高的药物性肝损伤(DILI)临床特点,以期正确治疗及准确判断预后。方法收集2013年2月—2015年8月就诊于河南省人民医院的ALT大于10倍正常上限(10ULN)的DILI患者的数据资料共300例,对资料完整的277例数据进行回顾性分析。结果277例DILI患者平均年龄(40.3±18.7)岁,男性︰女性为1.5︰1。ALT>10ULN的DILI患者中肝细胞型占比最多(65.7%),肝细胞型、混合型和胆汁淤积型患者治愈好转率分别是85.2%、91.0%、52.9%,胆汁淤积型与二者相比治愈好转率较低(P<0.05)。1级(轻度肝损伤)比2级(中度肝损伤)、3级(重度肝损伤)、4级(ALF)患者的ALT平均值低(P<0.05)。引起DILI的药物最常见为传统中药(TCM),其余为抗肿瘤药和抗感染药等。结论TCM、抗肿瘤药与抗感染药是引起DILI的主要原因;DILI患者男性多见,以肝细胞型居多,肝细胞型和混合型预后比较好。

Objective To study the clinical characteristics of patients in drug-induced liver injury(DILI)with significantly increased alanine aminotransferase(ALT),so as to correctly treat and accurately judge the prognosis.Methods A total of three hundred patients with DILI with ALT levels above 10 times upper limit of normal range(10 ULN)from February 2013 to August 2015 were retrieved,and 277 cases with complete clinical data were collected and analyzed retrospectively.Results The average age of 277 DILI patients with complete data was 40.3±18.7 years old,and the male to female ratio is 1.5︰1.Hepatocellular injury accounted for the largest proportion(65.7%).The prognosis of hepatocellular type,mixed type,cholestasis type was 85.2%,91.0%,52.9%.The prognosis of cholestasis type is lower(P<0.05).Level 1(Mild liver injury)in the mean ALT level is lower than level 2(moderate liver injury),level 3(severe liver injury),level 4(ALF)(P<0.05).The most common drug causing DILI is TCM,followed by antineoplastic drugs and anti-infective agents.Conclusion TCM,antineoplastic drugs,anti infective drugs may be the main causes of DILI in China.DILI patients are predominantly male,and most patients were hepatocellular.Prognosis of hepatocellular type and mixed type is relatively good.