药物性肝损伤的临床特点及相关药物分析

Clinical characteristics and related drugs analysis of drug-induced liver injury

目的分析药物性肝损伤(DILI)的临床特点及相关药物,为临床合理用药提供支持。方法选择2010年3月—2015年2月在宁夏医科大学总医院住院的DILI患者210例,回顾性分析患者的基本信息、用药情况、临床表现、相关药物及转归等情况。结果210例DILI患者中,>45岁126例,占60.00%;女性多于男性,男女比例为1∶1.39;临床分型以肝细胞型为主,占71.91%;临床表现以皮肤/巩膜黄染(21.87%)、乏力(16.67%)、尿黄(11.61%)、恶心(10.86%)较多见;引起DILI的药物主要为中药(43.96%)、抗菌药物(10.77%)、抗结核药(6.04%);临床治疗DILI时,使用率排名前3位的药物分别为门冬氨酸鸟氨酸(77.62%)、复方甘草酸苷(73.33%)和多烯磷脂酰胆碱(39.52%)。结论DILI的发病率随年龄增高而增加,且女性多发,中药导致的肝损伤最多,常表现为肝细胞型,患者经治疗后预后良好。临床医师及药师应对DILI引起重视,加强合理用药及DILI的预防、诊断和治疗。

Objective To analyze the clinical characteristics and related drugs of drug-induced liver injury(DILI)to provide support for clinical rational drug use.Methods Two hundred and ten patients with DILI hospitalized in the General Hospital of Ningxia Medical University from March 2010 to February 2015 were selected,and the basic information,drug use,clinical manifestation,related drugs and prognosis were retrospectively investigated.Results Of the 210 patients with DILI,126 were over 45 years old,accounting for 60.00%;Women were more than men,the ratio of men and women was 1∶1.39;Hepatocellular type was the main clinical type,accounting for 71.91%;The clinical manifestations were mainly skin/sclera yellow staining(21.87%),fatigue(16.67%),urine yellow staining(11.61%)and nausea(10.86%);The main drugs causing DILI were traditional Chinese medicine(43.96%),antibacterial drugs(10.77%)and anti-tuberculosis drugs(6.04%);In the clinical treatment of DILI,the top three drugs with highest usage rates were ornithine aspartate(77.62%),compound glycyrrhizin(73.33%)and polyene phosphatidylcholine(39.52%).Conclusion The incidence rate of DILI increases with age,and it is more common in women,the liver injury caused by traditional Chinese medicine is the most,often manifested as hepatocyte type,and the prognosis of patients is good after treatment.Clinicians and pharmacists should pay attention to DILI,strengthen rational drug use and prevention,diagnosis and treatment of DILI.