近5年我国药物性肝损伤患者临床特征分析  

Clinical features of patients with drug-induced liver injury in China in the last five years

作　　者：张艳梅[1] 孙文静[1] 文良志[1] 刘凯军[1] 王斌[1] 刘卉[1] 陈东风[1] 傅鑫[1] ZHANG Yanmei, SUN Wenjing, WEN Liangzhi, et al.(Department of Gastroenterology, Research Institute of Sargcry, Dapiug tl~spital, Third Military Medical University, Chongqing 400042, Chin)

机构地区：[1]第三军医大学大坪医院野战外科研究所消化内科,重庆400042

出　　处：《临床肝胆病杂志》2018年第3期562-566,共5页Journal of Clinical Hepatology

摘　　要：目的总结分析我国近5年来文献报道的药物性肝损伤(DILI)患者的临床特征。方法检索2012年1月-2016年12月我国DILI相关原始病例报道,并从中纳入202篇相关文献,共计26 015例DILI患者。总结DILI的性别、年龄及地域分布、致病药物、临床特征及预后情况。计数资料以率或构成比描述。结果 26 015例DILI患者中,男12 885例(49.53%),女13 130例(50.47%),平均46.86岁。排列前5位的致病药物分别为中药(34.68%)、抗结核药(15.81%)、抗微生物药(12.04%)、抗肿瘤药(9.09%)、解热镇痛药(6.17%)。临床表现主要为乏力(50.37%)、黄疸(52.68%)、纳差(43.59%)。158篇文献记录了19 994例患者DILl的分型,其中肝细胞型占58.84%、胆汁淤积型占21.79%、混合型占19.37%。肝活组织检查在诊断DILI中有一定价值。停用可疑药物,给予抗炎、保肝等综合治疗是DILI的主要治疗方式。179篇文献记录了22 030例患者的预后信息,其中治愈11 159例(50.65%)、好转8742例(39.68%)、无效1176例(5.34%)、死亡353例(1.60%)。结论国内文献报道DILI男女比例相当,中药引起的DILI最为常见,损伤类型以肝细胞型居多,治愈及好转率90.34%,患者大多预后良好。Objective To investigate the clinical features of patients with drug-induced liver injury（ DILI） in China in the last five years.Methods Related databases were searched for original case reports on DILI in China published from January 2012 to December 2017,and a total of 202 articles with 26 015 DILI patients were included in this analysis. Sex,age,geographical distribution,causative drugs,clinical features,and prognosis were summarized and analyzed. Categorical data were expressed as rate（ %） or constituent ratio. Results Of all 26 015 patients,12 885（ 49. 53%） were male and 13 130（ 50. 47%） were female,with a mean age of 46. 86 years. The five most common causative drugs were traditional Chinese medicine（ TCM）（ 34. 68%）,anti-tubercular agents（ 15. 81%）,anti-microbial drugs（ 12. 04%）,antitumor drugs（ 9. 09%）,and analgesic-antipyretic drugs（ 6. 17%）. Major clinical manifestations included fatigue（ 50. 37%）,jaundice（ 52. 68%）,and poor appetite（ 43. 59%）. A total of 158 articles recorded the typing of 19994 DILI patients,among whom 58. 84% had the hepatocellular type,21. 79% had the cholestasis type,and 19. 37% had the mixed type. Liver biopsy had a certain value in the diagnosis of DILI. Major therapies for DILI included withdrawal of suspected drugs,anti-inflammatory treatment,and liver protection. A total of 179 articles reported the prognosis of 22 030 patients,among whom 11 159（ 50. 65%） were cured,8742（ 39. 68%）were improved,1176（ 5. 34%） had no response,and 353 patients（ 1. 60%） died. Conclusion There is a similar incidence rate of DILI between male and female populations. TCM is the most common causative drugs for DILI. The hepatocellular type is the most common clinical type. The cured and improved rate is as high as 90. 34%,and most patients have good prognosis.

关 键 词：药物性肝损伤 MEDLARS 中国 

分 类 号：R575.1[医药卫生—消化系统]