166例药物性肝损伤临床特征和用药史分析

Clinical characteristics and medication history of 166 patients with drug-induced liver injury

目的了解药物性肝损伤的临床特征及用药史特点。方法收集重庆医科大学附属第一医院2018年1月—2022年6月期间住院的166例药物性肝损伤患者资料,按用药史分为中药、中成药或保健品致肝损伤组(HDS组,n=61),西药致肝损伤组(DILI组,n=65),混合用药组(MIX组,n=40),使用SPSS和EXCEL软件分析3组资料。结果多数患者为女性、小于60岁、BMI小于24 kg/m^(2)、无饮酒史、无药物性肝损伤病史、肝细胞型。DILI组有药物性肝损伤病史的患者最多(8例,χ^(2)=6.334,P=0.033);HDS组入院肝损伤分级(1/3/4/5)最高(14/45/2/0,χ^(2)=28.683,P<0.001),总胆红素水平[M(IQR)]最高[115.6(129.7),H=30.515,P<0.001]。HDS和DILI组患者人工肝使用率、激素使用率、住院天数和结局无显著差异。药物诱导的自身免疫性肝炎或胆管炎各1例(1.2%)。容易导致肝损伤的药物种类及用药时长中位数依次为中草药(26.5%)30 d、西药与其他药物混合用药(10.2%)22 d、抗结核药(9.6%)30 d、中成药(7.2%)30 d、解热镇痛抗炎药(6.0%)10.5 d、抗恶性肿瘤药(6.0%)1.5 d、多种类西药(6.0%)17.5 d、其他抗感染药(5.4%)3 d,用药不详(13.9%)25 d。结论药物性肝损伤患者通常是女性、非老年、正常或低体重、肝细胞型。使用抗肿瘤药后1 d、解热镇痛抗炎药10 d、抗结核药以外抗感染药3 d、其他药物1个月左右时查肝功能利于早发现肝损伤。多种药物混用是肝损伤的重要原因。由中药、中成药或保健品引起肝损伤的患者入院时总胆红素水平和肝损伤分级高于西药,但两者预后相同。

Objective To investigate the clinical characteristics and medication history of patients with drug-induced liver injury.Methods A total of 166 patients diagnosed with drug-induced liver injury and admitted to the first affiliated hospital of Chongqing Medical University between January 2018 and June 2022 were included in this study.Patients were divided into three groups based on their medication history:Chinese herbal medicine,Chinese patent medicine,or health products-induced liver injury group(HDS group,n=61),Western medicine-induced liver injury group(DILI group,n=65),and mixed medication group(MIX group,n=40).Statistical analysis was conducted using SPSS and EXCEL.Results The majority of patients were female,under the age of 60,with a BMI below 24 kg/m^(2),no history of alcohol consumption,and no prior drug-induced liver injury.They predominantly exhibited hepatocellular liver injury.Patients in the DILI group had the highest incidence of prior drug-induced liver injury(8 cases,χ^(2)=6.334,P=0.033).The HDS group showed the highest liver injury grade(1/3/4/5)on admission(14/45/2/0,χ^(2)=28.683,P<0.001),and significantly elevated total bilirubin level[115.6(129.7),H=30.515,P<0.001].There were no significant differences in the utilization of artificial liver,the use of hormone therapy,length of hospital stay,and clinical outcomes among the three groups.There was one case(1.2%)of drug-induced autoimmune hepatitis or cholangitis.The most common drugs causing liver injury included Chinese herbal medicine(26.5%)used for 30 days,Western medicine combined with other drugs(10.2%)for 22 days,anti-tuberculosis drugs(9.6%)for 30 days,Chinese patent medicine(7.2%)for 30 days,antipyretic-analgesic and anti-inflammatory drugs(6.0%)for 10.5 days,anti-malignant tumor drugs(6.0%)for 1.5 days,multi-type western drugs(6.0%)for 17.5 days,other anti-infective drugs(5.4%)3 for days,and unknown drug use(13.9%)for 25 days.Conclusion Patients with drug-induced liver injury are typically female,young,have normal or low weight,and tent to have hepatocellular type injury.Liver function tests should be conducted after a one-day course of antitumor drugs,a 10-day regimen of antipyretic analgesics and anti-inflammatory drugs,and a 3-day treatment with non-antituberculosis antibacterial agents to detect potential liver injury early.The concurrent use of multiple drugs emerges as a significant contributor to liver injury.Although patients with liver injury from Chinese herbal medicine,Chinese patent medicine,or health products exhibit higher total bilirubin levels and liver injury grades upon admission compared to those in the western medicine group,outcome were similar between the two groups.