65例药物性肝损伤的回顾性分析

A retrospective analysis of 65 cases of drug-induced liver injury

目的探讨药物性肝损伤(drug-induced liver injury,DILI)的临床特征,为临床早期识别、诊治DILI提供参考。方法回顾性分析2019年1月至2023年12月于广西中医药大学第一附属医院住院治疗的65例DILI患者的临床资料,统计分析其一般情况、用药情况、肝损伤的分布类型、中医药治疗情况与转归等信息。结果共纳入65例患者,男27例,女38例,平均年龄(46.40±19.19)岁,以41~60岁患者为主;诱发DILI的药物以中草药和中成药占比最高(30.8%)。DILI分型以肝细胞损伤型最多,共39例。DILI患者主要临床表现为乏力、腹部不适、厌油腻、身目黄染和尿黄等。中医药治疗中,运用频次最高的为甘草,使用频率达60.7%。经积极治疗后,59例患者病情好转或治愈出院。结论DILI分型以肝细胞损伤型为主,临床应加强对中草药及中成药肝毒性的监测,以减少药物不良反应对肝脏的损害。

Objective To explore the clinical characteristics of drug-induced liver injury(DILI),and provide reference for early clinical recognition,diagnosis and treatment of DILI.Methods Clinical datas of 65 patients with DILI hospitalized in the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2019 to December 2023 were retrospectively analyzed,and their general conditions,using drugs,distribution type of liver injury,traditional Chinese medicine treatment and outcome were statistically analyzed.Results A total of 65 patients were included,including 27 males and 38 females,with an average age of(46.40±19.19)years old.The majority of patients were 41 to 60 years old.Chinese herbal medicine and Chinese patent medicine accounted for the highest proportion of drugs inducing DILI(30.8%).Hepatocyte injury was the most common type of DILI,with 39 cases.The main clinical manifestations of DILI patients were fatigue,abdominal discomfort,aversion to oil,yellow eyes,yellow urine and so on.In the treatment of traditional Chinese medicine,liquorice root was the most frequently used,with a frequency of 60.7%.After active treatment,59 patients were cured and discharged from hospital.Conclusion Hepatocyte injury is the main type of DILI.Clinical monitoring of hepatotoxicity of traditional Chinese herbal medicine and Chinese patent medicine should be strengthened to reduce the damage to liver caused by adverse drug reactions.