以肝外表现首发的药物性肝损伤临床特征及误诊分析  

Clinical Characteristics and Misdiagnosis of Drug-Induced Liver Injury with Extraphepatic Manifestation as Initial Symptom

作　　者：池菲[1] 王晓静[1] 张媛媛 赵青[1] 李香兰[1] CHI Fei;WANG Xiao-jing;ZHANG Yuan-yuan;ZHAO Qing;LI Xiang-lan(Department of Emergency,Chest Hospital of Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省胸科医院急诊科,石家庄050000

出　　处：《临床误诊误治》2018年第10期49-52,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省卫计委重点科技研究计划(162247-5-1)

摘　　要：目的分析以肝外表现为首发症状的药物性肝损伤(drug-induced liver injury,DILI)的临床特点及误诊原因,以早期识别DILI、降低肝衰竭风险。方法回顾性分析我院急诊科2017年3月—2018年3月收治的以肝外表现首发的29例DILI临床资料。结果本组占同期收治DILI患者的22. 3%(29/130)。首发表现为发热10例,皮疹、关节疼痛各5例,肌肉疼痛4例,胸闷3例,高血糖、失眠各1例。29例中5例(17. 2%)误诊,误诊为肺部感染3例,药物过敏、类风湿关节炎各1例。29例经全面检查发现肝功能异常,排除器质性肝脏疾病,明确用药史后确诊为DILI。引起DILI的药物有抗结核药物、抗肿瘤药物、抗感染药物。确诊后及时停药,积极给予保肝及对症处理均恢复,无死亡病例。结论 DILI发病率愈来愈高,部分患者以肝外表现首发,临床表现不典型,临床医师需注意鉴别,确诊后及时妥善处理,以免引起急性肝衰竭。Objective In order to recognize the drug-induced liver injm7- （DILl） accurately in the early stage and reduce the risk of liver failme ,we analyzed the clinical characteristic of DILI which presented extraphepatic manifestation as initial symptom and investigated causes of misdiagnosis. Methods A retrospective analysis was per- fbmled on clinical data of 29 patients diagnosed with DILI that presented extraphepatic manifestation as initial symp- tom, which were collected in Emergency Department of our hospital flom March 2017 to March 2018. Results Of 130 patients with DILl, there were 29 patients who presented extraphepatic manifestation as initial symptom （22.3 %, 29/130）. The initial symptoms included fever （ u = l0 cases ）, rash （ u = 5 ）, arthrodynia （ u = 5 ）, myal- gia（u =4）, chest distress（u = 3）, hyperglycemia（u = 1 ） and insomnia （u = 1 ）. Five of the 29 cases （ 17.2% ） of DILl were misdiagnosed, including 3 cases of lung itffection, 1 case of drug hypersensitive reaction and 1 case of rheumatoid arthritis. All 29 patients had abnomlal liver function, excluding organic liver disease, and were diagnosed DILl based on detailed examination and medical history. The most common drugs causing DILl were antituberculosis drugs, antineoplastic drugs and antibacterial agents. The drug was withdrawn after diagnosis and liver protection and symptomatic treatment was given. All patients were recovered and no death was reported. Conclusion The inci- dence of DILl is higher. Some patients present extraphepatic manifestation as initial symptom with atypical clinical manifestations. Therefore, the clinician should pay attention to differential diagnosis and timely treatment of DILl to avoid acute liver failure.

关 键 词：药物性肝损伤 药物毒性 误诊 感染 药物过敏 类风湿性关节炎 

分 类 号：R575.1[医药卫生—消化系统]