Objective To analyze the etiology,clinical features and prognosis of liver injuries caused by different drugs.Methods The types of suspected drugs related to liver injury,clinical manifestations,liver biochemical parameters,clinical outcomes and other associated data were retrospectively assessed for 140 patients with drug-induced liver injury (DILI).The Roussel Uclaf Causality Assessment Method (RUCAM) was used to assess the causality between drugs and liver injury.Results The most prevalent agents inducing DILI were Chinese traditional drugs (62.1％),followed by antipyretic analgesic drugs (10％) and antibiotics (5％).The ratio of male to female patients in the study cohort was 1∶1.69,with 71 of the total patients (50.7％) being between the ages of 40 and 60 years-old.The RUCAM scale was not less than 3 points for any of the patients.In general,the clinical manifestations and biochemical results were not specific.The percentages of hepatocellular injury type,cholestatic injury type and mixed injury type were 51.4％,30.7％ and 17.9％ respectively.The median age of patients with cholestatic liver injury was 55.6 years,which was older than that of patients with hepatocellular injury (47.1 years) or mixed injury (49.9 years).Conclusion Although antipyretic analgesics and antibiotics are considered as common drugs that can induce DILI,Chinese traditional drugs have emerged as another important group of liver injurious agents.Cholestatic DILI was found to occur more often in elderly patients than in younger patients.%目的 探讨药物性肝损伤(DILI)的病因构成及临床和预后特点. 方法 回顾性分析解放军第八一医院全军肝病中心2012年7月至2013年7月诊断为DILI的140例患者的临床资料,采用RUCAM量表评价药物应用史与肝损伤的相关性,并分析药物种类构成、DILI的临床类型及预后特点.结果 引起本组患者DILI的前3位药物为中药87例(62.1％)、解热镇痛药14例(10％)、抗生素7例(5％).男女性别比为1∶1.69.＞40 ～ ＜60岁患者71例(50.7％).患者RUCAM分值均≥3,临床表现无明显特异性,肝细胞损伤型DILI最多见,共72例(51.4％),胆汁淤积型43例(30.7％),混合型25例(17.9％);胆汁淤积型DILI患者的中位年龄(55.6岁)较肝细胞型(47.1岁)及混合型DILI (49.9岁)高.药物性急性肝衰竭患者占7.86％.结论 本研究患者中因中药引起的DILI所占比例最高,应引起高度重视;其次为解热镇痛药物和抗生素类药物.DILI的临床表现缺乏特异性,但老年患者相对易出现胆汁淤积.绝大多数DILI患者预后良好.
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