药物性肝损伤100例临床特点分析

摘要

目的 分析药物性肝损伤(DILI)的临床特点,从而为临床DILI的预防、诊断、治疗和预后提供参考.方法 回顾性分析2012年12月至2014年12月昆明医科大学第一附属医院收治的100例诊断为DILI患者的完整病例资料,对患者性别、年龄、用药种类、临床表现、临床分型、治疗和转归的相关数据进行分析.结果 导致DILI的药物种类繁多,前5类药物依次为中药46例(43.4％)、抗肿瘤药7例(6.6％)、抗微生物用药6例(5.7％)、抗结核药5例(4.7％)和解热镇痛药4例(3.8％).DILI的临床表现多种多样,无特异性,主要有尿黄、皮肤黏膜黄染、食欲减退、乏力、恶心等.临床分型:肝细胞型49例(49.0％),胆汁淤积型28例(28.0％),混合型23例(23.0％).临床治疗中,采取解毒、降酶、保肝、促进药物和胆汁排泄等对症支持治疗,重症患者加用人工肝脏支持治疗.经积极治疗后,3例(3.0％)治愈,88例(88.0％)好转出院,9例(9.0％)自动出院,总体预后良好.平均住院时间为(14.1±7.4)d.结论 DILI好发于中、老年女性,致病药物种类繁多,而中药是最常见的致病药物.DILI的临床表现多种多样,无特异性,临床分型以肝细胞型最多见.经积极治疗后,总体预后良好,但应警惕严重肝衰竭的发生.%Objective To analyze the clinical charateristics of drug-induced liver injury (DILI),thus provide references for prevention,diagnosis,treatment and prognosis of clinical DILL Methods One hundred patients with DILI hospitalized in the First Affiliated Hospital of Kunming Medical University from Dec.2012 to Dec.2014 were enrolled as subjects.And a retrospective analysis on their data of gender,age,medication,clinical symptoms,clinical classification,treatment and prognosis was done.Results There were plenty of drugs which could cause DILI.The top 5 drugs inducing DILI were 46 cases (43.4％) with Chinese herbs,7 cases (6.6％) with antineoplastics,6 cases (5.7％) with antibiotics,5 cases (4.7％) with antituberculotics and 4 cases(3.8％) with anti-inflammatory drugs.There were various clinical symptoms of DILI,with no specificity,the main clinical symptoms were yellow urine,jaundice,anorexia,fatigue,nausea and so on.According to clinical classification,there were 49 cases with hepatocellular type (49.0％),28 cases with cholestatic type (28.0％),and 23 cases with mixed type (23.0％).In treatment,there were all kinds of symptomatic supportive therapies such as detoxification,reducing liver enzymes,protecting liver,promoting excretion of drugs and choler and so on.Serious patients could adopt artificial liver as supportive therapy.After active treatment,3 patients(3.0％) were cured,88 patients (88.0％) were improved,9 patients (9.0％) were discharged,and the total prognosis was favorable.The mean time of hospitalization was (14.1-±7.4) days.Conclusion The DILI is more common in elderly women.There are a wide variety of drugs which can cause DILI,and the most common drugs are Chinese herbs.There are various clinical symptoms of DILI,but none of them is specific.The major clinical type is hepatocellular type.After effective treatment,the total prognosis is favorable,but the onset of serious liver failure still needs to be taken into account.