219例药物性肝损伤患者临床特征和预后分析

Clinical feature and prognosis of patients with drug-induced liver injury:An analysis of 219 cases

目的分析药物性肝损伤(DILI)患者的临床特征,为临床合理用药、早期发现及诊断提供参考。方法2012年1月~2020年12月广西医科大学第一附属医院住院治疗的诊断为DILI患者219例,经Roussel Uclaf因果关系评估方法(RUCAM)评分≥6分诊断,并将肝损伤程度分为1级(轻度)、2级(中度)和3级、4级、5级(重度)。结果在本组219例DILI患者中,最常见的可疑致病药物为中药类(30.1%)、抗结核药物(12.3%)、抗生素(11.9%)、抗肿瘤及免疫抑制剂(7.8%)和解热镇痛药(6.4%);肝细胞损伤型160例,胆汁淤积型42例,混合型17例;三型性别和年龄分布差异无统计学意义(P>0.05);严重程度1级100例,2级32例,3级以上87例;胆汁淤积型和混合型患者重度肝损伤占比分别为57.1%和53.0%,均显著高于肝细胞损伤型的33.7%(P<0.05);肝细胞损伤型治愈或好转率为93.8%,显著高于胆汁淤积型的61.9%或混合型的70.6%(P<0.01)。结论了解临床常导致DILI的可疑药物、临床类型和病情评估方法对于预防、早期诊断和及时处理都很重要,需要进一步规范处置流程,防止病情进展。

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 data of 219 hospitalized patients with DILI was analyzed,who were encountered in First Affiliated Hospital,Guangxi Medical University between January 2012 and December 2020.The diagnosis was made by the RUCAM score≥6.The suspect medicines,clinical features,disease severity and outcomes were retrospectively analyzed,and the disease severity was classified as mild,moderate and severe.Results In our series of 219 patients with DILI,the top five suspected medicines that most frequently caused DILI were Chinese herbal medicine(30.1%),anti-tuberculosis agents(12.3%),antibiotics(11.9%),anti-tumor and immunosuppressive medicines(7.8%)and antipyretic analgesics(6.4%);the clinical types included hepatocyte injury type in 160 cases,cholestasis type in 42 cases and mixed type in 17 cases;there was no significant differences in gender and age distribution among the three types of clinical types(P>0.05);there were 100 patients with disease severity of grade 1,32 patients with grade 2 and 87 patients with grade 3 or above;the percentages of severe type in patients with cholestasis type and mixed type were 57.1%and 53.0%,both significantly higher than 33.7%(P<0.05)in patients with hepatocyte injury;the recovery rate in patients with hepatocyte injury was 93.8%,much higher than 61.9%in patients with cholestasis type or 70.6%in patients with mixed type(P<0.01).Conclusion The common suspected medicines which could lead to DILI in clinical practice are mainly traditional Chinese herbal medicines,anti-tuberculosis agents and antibiotics.The clinical classification is mainly hepatocellular injury type,and the proportions of severe liver injury in patients with cholestasis and mixed type are significantly higher than that in those with hepatocyte injury type.The outcomes of patients with hepatocyte injury is relatively promising.