100例药物性肝损伤的影响因素与治疗方法分析

Influencing factors and treatment of drug-induced liver injury

目的分析厦门市海沧医院就诊患者发生药物性肝损伤(DILI)的影响因素及治疗方法,为临床提供合理的药物选择与治疗依据。方法收集2013年1月1日至2020年1月1日我院就诊发生DILI的100例患者及其用药的相关信息,进行统计与分析。结果引起DILI药物种类主要有抗感染药物、中药、降血脂药、抗肿瘤药、解热镇痛药等。DILI发生时间在用药4周内的例数最多,共72例。男性患者51例的DILI发生率略高于女性49例;平均年龄为(51.0±17.7)岁,其中41~60岁的患者中DILI的发生率最高(38.00%);在并发症方面,82例有基础疾病,占总例数的82%。不同性别、年龄段及是否合并基础疾病的DILI发生率均无统计学意义(P>0.05)。发生DILI后采取停药72例,继续用药23例,药物减量3例,未知2例。有39例使用1种保肝药治疗,36例联合使用2种保肝药治疗,16例联合使用3种保肝药治疗,未用4例,不详5例。91例使用保肝药治疗预后情况有23例治愈,45例好转,14例未愈,9例未知。结论引起药物性肝损伤的药物主要为抗感染药物,其次为中药。其中抗感染药物中抗真菌药、抗分枝杆菌药引起肝损伤的比率位居前列;治疗方法主要包括及时停用肝毒性药物和使用保肝药支持治疗;DILI预后情况总体良好,中老年人发病率较高。临床使用相关药物应加强监测,及时采取相应措施,以预防及减少DILI的发生。

Objective To study the influencing factors and treatments of drug-induced liver injury(DILI) in our hospital in recent years and to provide data for clinical drug selection and treatment. Methods The data on patients with DILI between January 1, 2013 and 2020 January 1, was collected and analyzed. Results The main types of drugs that induced DILI were anti-infective drugs, traditional Chinese medicine, anti-lipidemic drugs, anti-tumor drugs, antipyretic and analgesic drugs. DILI was most likely to occur within 4 weeks of medication(72 cases). The incidence of DILI was slightly higher in male patients(51.00%) than in female ones(49.00%), and the average age was(51.0±17.7). The incidence of DILI was the highest among patients aged 41 to 60(38.00%). In terms of complications, 82 cases had preexisting diseases. There was no significant difference in the incidence of DILI between different genders, age groups or between people with or without preexisting diseases(P>0.05). After drug-induced liver injury, 72 cases stopped taking drugs, 23 cases continued to take drugs, and 3 cases decreased the dosage. Among the 91 cases treated with hepatoprotective drugs, cases 23 were cured, 45 cases improved, 14 cases not cured and 9 cases unknown. Conclusion The dominating drugs that cause DILI are anti-infective drugs, followed by traditional Chinese medicine. The prognosis of DILI is generally good, and the incidence is relatively high among middle-aged and elder people. In order to prevent and reduce the occurrence of DILI, clinicians should strengthen monitoring and take immediate measures.