沈阳地区药物性肝损伤病因和损伤类型  

Etiology and injury types of drug-induced liver indury in Shenyang

作　　者：陈昶铭[1] 常冰[1] 张岱[1] 向国卿[1] 贺晓虎[1] 王炳元[1] 

机构地区：[1]中国医科大学附属第一医院消化内科,辽宁省沈阳市110001

出　　处：《世界华人消化杂志》2008年第22期2525-2528,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨沈阳地区药物性损伤(drug-induced liver injury,DILI)的病因和损伤类型.方法:回顾性分析2000-01/2004-06在中国医科大学附属第一医院消化内科住院的DILI患者181例,所有患者均诊断明确.结果:引起肝损伤的相关药物中最常见的为:中草药类(50.27%);抗生素类药物(15.47%);非甾体类抗炎药(15.47%).生化检查主要表现在酶学改变和胆红素排泄障碍,而早期对蛋白合成功能几乎无影响.损伤类型中肝细胞型106例(58.56%);胆汁淤滞型36例(19.89%);混合型17例(9.39%);不确定的22例(12.15%).中草药导致的胆汁淤积型中高达83.3%,其发病率明显高于肝细胞型(χ2=78.981,P<0.001);其他药物均以肝细胞损伤为主.结论:沈阳地区50.27%的DILI是中草药引起,单纯生化学检查可粗略估计DILI的细胞损伤类型,即ALT增高反映肝细胞型,ALP、GGT增高反映胆道系统的损伤.AIM： To discuss the etiology and types of druginduced liver injury （DILI） in Shenyang City of China. METHODS： We retrospectively analyzed 181 patients diagnosed with DILI in gastrointestinal department of the first affiliated hospital of China Medical University from January 2000 to June 2004. RESULTS： The common drugs that induced liver injury were Chinese herbal medicine （50.27%）, antibiotics （15.47%）, and non-steroid anti-inflammatory drugs （15.47%）. Bilirubin paraeccrisis and enzyme changes were the main manifestations in biochemical examination, while protein synthesis at early stage hardly changed. The injuries included hepatic cell type （n = 106; 58.56%）, cholestatis type （n = 36; 19.89%）, mixed type （n = 17; 9.39%）, and uncertained type （n = 22; 12.15%）. Chinese herb-induced cholestasis was up to 83.3%, and its incidence rate was obviously higher than hepatic cell type （x^2 = 78.981, P 〈 0.001）. Other drugs induced hepatic cell injury most. CONCLUSION： Half of DILI in Shenyang are caused by Chinese herbal medcine, and biochemical examnation can simply and roughly estimate its injury type.

关 键 词：药物性肝损伤 中草药 生化学检查 

分 类 号：R595.3[医药卫生—内科学]