药物性肝损伤157例的临床特点及预后分析  

Clinical and prognostic analysis of 157 patients with drug-induced liver injury: a retrospective study

作　　者：窦永青[1] 郭荣荣[1] 张缭云[1] 郝彦琴[1] 卫飞燕 DOU Yongqing;GUO Rongrong;ZHANG Liaoyun;HAO Yanqin;WEI Feiyan(Department of Infectious Diseases,First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院感染病科,太原030001

出　　处：《山西医科大学学报》2018年第7期768-772,共5页Journal of Shanxi Medical University

摘　　要：目的探讨药物性肝损伤(drug-induced liver injury,DILI)患者的临床特征、治疗及预后,并对诱发DILI的药物情况进行总结,为DILI的诊断、防治提供参考。方法回顾性分析我院2012-01~2017-12收治的157例DILI住院患者的性别、年龄、基础疾病、肝损伤诱发药物种类和名称、临床表现、肝功能、治疗及预后等。结果 DILI诊断病例数逐年增加,其中男性50例(31.8%),女性107例(68.2%),患者年龄11-79岁,平均(45.1±14.4)岁。本组病例中引起肝损伤的药物中,中药44例(28.0%),联合用药36例(22.9%),抗菌药物16例(10.2%),内分泌及代谢类用药15例(9.6%)。临床分型:肝细胞损伤型100例(63.7%),胆汁淤积型52例(33.1%),混合型5例(3.2%)。预后:治愈61例(38.9%),好转85例(54.1%),无效8例(5.1%)及死亡2例。结论引起药物性肝损伤的药物种类繁多,临床表现无特异性。临床分型多数为肝细胞损伤型,经及时治疗后大多预后较好,但仍有少数可发展至肝功能衰竭。因此临床医生在使用药物治疗疾病时务必提高安全用药意识,注意药品不良反应尤其是药物性肝损伤,做到早预防、早诊断、早治疗。Objective To investigate the clinical characteristics,treatment and prognosis of drug-induced liver injury(DILI)related to the variety of hepatotoxic agents,and to provide a reference for the diagnosis,prevention and treatment of DILI.Methods The basic information,clinical data,treatment and prognosis of 157 patients with DILI from January 2012 to December 2017 were retrospectively analyzed.Results Among 157 patients aged 11-79 years,there were 50 male cases(31.8%)and 107 female cases(68.2%).The most common etiologies associated with DILI were traditional Chinese medicine(28.0%),drug combination(22.9%),antimicrobials(10.2%),chemotherapeutics(11.4%),antilipidemics(7.1%),and endocrine and metabolic agents(9.6%).The patients exhibited three clinical types:63.7%of hepatocytes,33.1%of cholestasis type,and 3.2%of mixed type.After the diagnosis,the patients were all given conservative treatment with liver-protecting drugs.A total of 61 cases(38.9%)were healed,85 cases(54.1%)got better and 2 cases died.Conclusion A kind of drugs could cause drug-induced liver injury,and the clinical manifestations of drug-induced liver injury are not specific.The main clinical type is hepatocellular injury,and most of patients have good prognosis after the timely treatment,but there are still a few patients that could develop to liver failure.Drug-induced liver disease should be paid more attention and get earlier prevention and treatment.

关 键 词：药物性肝损伤 临床特征 回顾性分析 预后 

分 类 号：R575[医药卫生—消化系统]