药物性肝损伤患者临床特征分析

Analysis of Clinical Characteristics of Patients with Drug-induced Liver Injury

背景:药物性肝损伤(DILI)是一类临床常见疾病,临床表现不典型,易误诊、漏诊。目的:探讨DILI患者的临床特征。方法:收集厦门大学附属中山医院2014年1月—2015年12月收治并确诊的DILI患者的临床资料,回顾性分析其临床特征,并探讨临床特征与预后的相关性。结果:共纳入DILI患者51例,男女比例为1∶1.32,平均年龄(50.6±17.9)岁,其中60岁及以上人群占比最高(43.1%)。肝细胞损伤型为主要肝损伤类型(84.3%)。引起DILI最常见的药物依次为中草药、心血管系统药以及激素和内分泌代谢药,分别占51.0%、19.6%和9.8%。患者合并的基础疾病涵盖全身多个系统。DILI临床表现不典型,实验室检查亦缺乏特异性,5.9%的患者自身抗体阳性。大部分DILI患者预后较好,治愈率和好转率分别为21.6%和66.7%,死亡率为5.9%,死因均为肝衰竭。患者入院时丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、白蛋白水平和凝血酶原时间(PT)、凝血酶原时间国际标准化比值(INR)与预后显著相关(P<0.05)。结论:DILI好发于老年人群,中草药的不规范使用可能是导致其发生的重要因素。DILI临床表现不典型,大部分患者预后较好。入院时ALT、AST、TBIL、白蛋白水平和PT、INR与预后密切相关。

Background: Drug-induced liver injury( DILI) is a kind of commonly seen diseases,in which typical clinical manifestations are lacking and misdiagnosis and missed diagnosis are frequently occurred. Aims: To investigate the clinical characteristics of patients with DILI. Methods: Clinical data of patients with DILI at Zhongshan Hospital,Xiamen University from January 2014 to December 2015 were collected. Clinical characteristics were retrospectively analyzed and the relationship between clinical characteristics and prognosis was investigated. Results: A total of 51 patients with DILI were enrolled,the ratio of male to female was 1 ∶ 1. 32,the average age at diagnosis was( 50. 6 ± 17. 9) years old,the highest proportion( 43. 1%) of patients were aged 60 and older. Hepatocellular damage was the main type of liver injury( 84. 3%). Chinese herbs,cardiovascular drugs,hormone and endocrine drugs were the most common drugs causing DILI,which accounted for 51. 0%,19. 6% and 9. 8%,respectively. Concomitant diseases of DILI covered many systems. The clinical manifestation of DILI was atypical,and the laboratory examination also lacked specificity. The positivity rate of autoimmune antibody was 5. 9%. Most patients had good prognosis,and the cure rate and improvement rate were 21. 6%and 66. 7%,respectively. The mortality rate was 5. 9% with the cause of death being liver failure. Levels of alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBIL),albumin,prothrombin time( PT)and international normalized ratio( INR) at admission were correlated significantly with prognosis( P < 0. 05).Conclusions: DILI commonly occurs in elderly population,and inappropriate use of Chinese herbs maybe the important cause. The clinical manifestation of DILI is not typical,and most patients have good prognosis. Levels of ALT,AST,TBIL,albumin,PT and INR at admission are correlated significantly with prognosis.