药物性肝损伤患者临床特点及预后分析

Clinical features and prognosis of patients with drug-induced liver injury

目的回顾总结药物性肝损伤(DILI)患者的临床特点。方法2015年1月~2019年12月我院诊治的DILI患者164例,收集临床资料,总结其临床特点和预后。结果本组DILI患者被诊断为肝细胞型97例,胆汁淤积型24例,混合型43例;肝细胞型患者年龄为(47.2±13.3)岁,显著小于其他两型(P<0.05);血清ALT水平为(652.5±350.6)U/L,显著高于其他两型【分别为(72.6±52.8)U/L和(180.6±118.5)U/L,P<0.05】,血清AST水平为(451.8±418.1)U/L,显著高于其他两型【分别为(85.5±75.2)U/L和(156.0±144.5)U/L,P<0.05】,而胆汁淤积型血清ALP水平为(268.8±212.8)U/L,显著高于其他两型【分别为(84.5±17.5)U/L和(209.1±144.5)U/L,P<0.05】,血清TBIL水平为(66.8±13.5)μmol/L,显著高于其他两型【肝细胞型为(22.3±2.3)μmol/L和混合型为(47.8±23.8)μmol/L,P<0.05】;本组由西药导致的DILI患者45例,中成药106例,中西药导致的13例;西药导致的DILI组年龄为(44.2±13.5)岁,显著年轻于其他两组(P<0.05),男性占比为42.2%,显著高于其他两组的33.0%和30.8%;血清ALT水平为(510.2±361.8)U/L,显著高于其他两组【中成药组为(172.8±59.1)U/L和中西药组为(278.4±327.2)U/L,P<0.05】,血清AST水平为(360.8±251.5)U/L,显著高于其他两组【分别为(134.5±39.2)U/L和(249.4±228.1)U/L,P<0.05】,而中成药组血清ALP水平为(174.7±113.6)U/L,显著高于其他两组【西药组为(102.2±184.6)U/L,中西药组为(203.4±152.4)U/L,P<0.05】,血清TBIL水平为(93.9±46.2)μmol/L,显著高于其他两组【分别为(14.3±4.1)μmol/L和(52.0±12.0)μmol/L,P<0.05】;本组DILI患者痊愈141例,未痊愈23例;未痊愈组男性占比为52.2%,显著高于痊愈组的32.6%(P<0.05),肝细胞型占比为39.1%,显著低于痊愈组的62.4%(P<0.05),中成药致病占比为78.2%,显著高于痊愈组的62.4%(P<0.05)。结论本组DILI患者临床表现符合一般报道的特征,大多预后良好。中成药致病者可能出现高黄疸而病情迁延,值得认真对待。

Objective The purpose of this study was to summarize the clinical features and prognosis of patients with drug-induced liver injury(DILI).Methods The clinical materials in 164 patients with DILI between January 2015 and December 2019 were reviewed.The diagnosis of DILI was in accordance with the guidelines for the diagnosis and treatment of drug-induced liver injury reported by the Hepatology Branch of the Chinese Medical Association in 2015.Results Out of the 164 patients with DILI,the hepatocyte injury type was found in 97,the cholestasis type in 24,and the mixed type in 43;the average age in patients with hepatocyte injury was(47.2±13.3)yr,significantly younger than those in other two groups(P<0.05);serum ALT level in patients with hepatocyte injury was(652.5±350.6)U/L,in other two groups[(72.6±52.8)U/L and(180.6±118.5)U/L,respectively,P<0.05],significantly higher than those serum AST level was(451.8±418.1)U/L,much higher than in other two groups[(85.5±75.2)U/L and(156.0±144.5)U/L,P<0.05],while serum ALP level in patients with cholestasis type was(268.8±212.8)U/L,significantly higher than in other two groups[(84.5±17.5)U/L and(209.1±144.5)U/L,respectively,P<0.05],and serum bilirubin level was(66.8±13.5)μmol/L,also significantly higher than in other two groups[(22.3±2.3)μmol/L in hepatocyte injury and(47.8±23.8)μmol/L in mixed type,P<0.05];the western medicine-,herbal medicine-and both-induced DILI accounted for 27.4%,64.6%and 7.9%,respectively;the average age in 45 patients with western medicineinduced DILI was(44.2±13.5)yr,significantly younger than in other two groups(P<0.05),and male accounted for 42.2%,significantly higher than 33.0%in 106 patients with herbal medicine-induced DILI or 30.8%in 13 patients with western and herbal medicine-induced DILI;serum ALT level in western medicine-induced DILI was(510.2±361.8)U/L,significantly higher than[(172.8±59.1)U/L in herbal medicine-induced or(278.4±327.2)U/L in both-induced,P<0.05],serum AST level was(360.8±251.5)U/L,significantly higher than[(134.5±39.2)U/L or(249.4±228.1)U/L,P<0.05]in other two groups,while serum ALP level in herbal medicine-induced DILI was(174.7±113.6)U/L,much higher than in other two groups[(102.2±184.6)U/L and(203.4±152.4)U/L,P<0.05],and serum bilirubin level was(93.9±46.2)μmol/L,significantly higher than in other two groups[(14.3±4.1)μmol/L and(52.0±12.0)μmol/L,P<0.05];141 patients recovered and 23 not in our series;the male accounted for 52.2%in those unrecovered,significantly higher than 32.6%(P<0.05)in recovered,the hepatocyte injury accounted for 39.1%,significantly lower than 62.4%(P<0.05)in recovered,and herbal medicine-induced accounted for 78.2%,much higher than 62.4%(P<0.05)in recovered.Conclusion The clinical features of patients with DILI in our series are common with good prognosis,and the patients with herbal medicine-induced DILI tend to be with hyperbilirubinemia,whom should be taken more attention and dealt with appropriately.