药物性肝衰竭临床特点分析

摘要

Objective To explore the etiology, clinical characteristics and prognosis of drug-induced liver failure in southwest China. Method The clinical data of 66 patients with DILF hospitalized in southwest hospital of China from 2000 to 2012 were retrospectively analyzed. Result Of these 66 patients, 13 cases were acute, 43 cases were subacute and 10 cases were acute on chronic. 12 cases in the early stage, 27 cases in the middle stage and 27 cases in the late stage. Liver failure caused by the main three kinds of drugs were anti-tuberculosis drugs, followed by Chinese medicine, immunosuppressants. 12 cases with acute liver failure, 26 cases with sub-acute liver failure and 3 cases with acute on chronic were induced by western drugs;1 case with acute liver failure, 17 cases with sub-acute liver failure and 7 cases with acute on chronic were induced by Chinese herbs. Hepatocellular type accounted for 24.2%(16/66), cholestasis type accounted for 51.5%(34/66), and hybrid accounted for 24.2%(16/66). Prognosis and liver damage types of Chinese and western medicine had no statistical signiifcance (P>0.05). Improvement and invalid group in age, gender, total bilirubin, direct bilirubin and alkaline phosphatase distribution had no statistical signiifcance (P > 0.05). Treatment failure patients the incidence of complications were higher than that of the improved (P<0.01). Conclusion Anti-TB drugs is the main cause of drug-induced liver failure in the southwest, it familiarly lead to sub-acute liver failure;liver cell damage types are mainly composed of cholestasis type;effective prevention and treatment of hepatic encephalopathy, infection and other complications has an important significance to improve the prognosis in patients with DILF.%目的：探索中国西南地区药物性肝衰竭病因构成、临床特征及预后。方法回顾性分析2000～2012年本院收治的66例药物性肝衰竭患者临床资料，所有患者均来自我国西南地区，对其临床特征进行总结。结果66例药物性肝衰竭患者中，急性13例，亚急性43例，慢加急性10例；早期12例，中期27例，晚期27例。引起肝衰竭的主要药物依次为抗结核药物、中草药、免疫抑制剂。西药引起急性药物性肝衰竭12例，亚急性肝衰竭26例，慢加急性3例；中草药引起急性药物性肝衰竭1例，亚急性17例，慢加急性7例。药物性肝衰竭肝细胞损伤型占24.2%（16/66），胆汁淤积型占51.5%（34/66），混合型占24.2%（16/66），中、西药治疗的患者肝损伤类型及预后比较差异均无显著性（P＞0.05）。好转与无效者在年龄段、性别、总胆红素、直接胆红素及碱性磷酸酶分布方面比较差异均无显著性（P＞0.05）；治疗无效患者的并发症发生率均高于好转者，差异均有显著性（P＜0.01）。结论在西南地区抗结核药物是引起药物性肝衰竭主要原因，以亚急性多见；肝细胞损伤类型以胆汁淤积型为主；有效积极地预防与治疗肝性脑病及感染等并发症对该类患者预后具有重要意义。