105例药物性胆汁淤积型肝损伤患者临床特征分析

Analysis of clinical characteristics of 105 cases ofcholestatic drug-induced liver injury

目的探讨药物性胆汁淤积型肝损伤患者基本信息、临床特征、影像学表现及转归。方法回顾性分析近5年来的住院患者中诊断为药物性胆汁淤积型肝损伤的病例资料,记录其临床数据,至少随访6个月。结果共有105例药物性胆汁淤积型肝损伤患者,中位年龄55岁,男性占比54.3%,多无特异性临床症状。所涉及的药物近80余种,前3位依次为中药(34.3%)、抗肿瘤药(22.9%)、抗生素(10.5%)。49例行磁共振胰胆管成像患者中,有7例(14.3%)患者存在硬化性胆管炎样改变。105例患者中治愈53例(50.5%),好转41例(39.0%),未愈7例(6.7%),死亡4例(3.8%),总有效率为89.5%。结论药物性胆汁淤积型肝损伤主要发生于老年患者,涉及药物种类较多,以中药最为多见。药物还可引起类似于硬化性胆管炎样改变,因此应将药物性胆汁淤积型肝损伤作为胆汁淤积和胆管造影异常患者的鉴别诊断之一。基础肝病对患者预后无影响。二元Logistic逐步回归分析示:Roussel Uclaf因果关系评价法(RUCAM)评分低、血红蛋白水平低、住院时间短以及白细胞计数高是药物性胆汁淤积型肝损伤患者转归的独立危险因素。

Objective To explore the general information,clinical features,imaging findings and outcome of patients with drug-induced cholestatic.Methods The clinical data of patients diagnosed as cholestatic drug-induced liver injury in recent 5 years were analyzed retrospectively,and followed up for at least 6 months.Results There were 105 patients with drug-induced cholestatic liver injury in the hospital,the median age was 55 years old(54.3%male),most of them had no specific clinical symptoms;there were nearly 80 kinds of drugs involved,the top three were traditional Chinese medicine(34.3%),antineoplastic drugs(22.9%)and antibiotics(10.5%).Among the 49 patients with magnetic resonance cholangiopancreatography(MRCP),7(14.3%)had sclerosing cholangitis-like changes;most of the patients were combined with multiple liver-protecting and enzyme-lowering drugs;there were 53 cured(50.5%),41 improved(39.0%),7 uncured(6.7%),and 4 died(3.8%)among 105 patients,and the total effective rate was 89.5%.Conclusion Drug-induced cholestatic liver injury mainly occurs in elderly patients,involving many kinds of drugs,mainly traditional Chinese medicine.Drugs can also cause changes similar to sclerosing cholangitis,so drug-induced liver injury(DILI)should be used as one of the differential diagnosis of cholestasis and abnormal cholangiography.Liver disease and the number of drugs have no effect on the prognosis of the patients,while low Roussel Uclaf causality assessment method(RUCAM)score and hemoglobin count,short hospitalization time and high white blood cell count are poor prognostic factors.