药物性肝损伤与慢性肝病急性加重相关性的临床研究——附301例分析  

Correlation between drug-induced liver injury and acute exacerbation of chronic liver disease: a clinical study of 301 cases

作　　者：卢俊竹 陈广成[2] 陈慧[2] 刘思齐[2] 詹俊[2] Lu Junzhu;Chen Guangcheng;Chen Hui;Liu Siqi;Zhan Jun(Department of Gastroenterology,Jieyang People’s Hospital,Jieyang 522000,China)

机构地区：[1]揭阳市人民医院消化内科,揭阳522000 [2]中山大学孙逸仙纪念医院消化内科,广州510030

出　　处：《新医学》2020年第2期138-142,共5页Journal of New Medicine

摘　　要：目的比较不同诱因所致慢性肝病急性加重(AE-CLD)的临床特征及其对预后的影响,分析药物性肝损伤(药肝)诱发AE-CLD的药物类型分布。方法收集AE-CLD患者病例资料并随访3个月内的全因死亡率,进行观察性的临床研究。结果共收集301例AE-CLD患者,年龄(49.7±12.8)岁,男性患者235例(78.1%),慢性肝病基础以乙型肝炎、酒精性肝病为主(共占79.1%)。其中,药肝诱因组66例(药肝组,占21.9%),非药肝诱因组235例(非药肝组,占78.1%)。药肝组总胆红素、AST、ALT、碱性磷酸酶、γ-谷氨酰转移酶、总胆固醇、总胆汁酸、进展为慢性肝病加急性肝衰竭比例均高于非药肝组,且凝血功能更差,以上差异均有统计学意义(P均<0.05)。随访所有患者住院时间以及28 d、90 d的全因死亡率,提示药肝组均高于非药肝组,差异均有统计学意义(P均<0.05)。药肝组中,肝损伤药物类型主要为中草药(占33.3%)、解热镇痛药(占31.8%),余为抗菌药物、调脂药、其他或未明药物。结论药肝与非药肝因素所致AE-CLD的临床特征有所差异;与非药肝因素相比,药肝诱发AE-CLD的患者住院时间更长、短期病死率更高、预后更差;药肝诱发AE-CLD的药物以中草药、解热镇痛药、抗菌药物及调脂药为主。Objective To compare the clinical features of acute exacerbation of chronic liver disease(AE-CLD) caused by different inducements and their influence on clinical prognosis,and to analyze the drug distribution of AE-CLD caused by drug-induced liver injury(DILI).Methods In this observational clinical trial,clinical data of AE-CLD patients were collected.All-cause mortality rate was followed up within3 months.Results A total of 301 AE-CLD patients were collected in this study,aged(49.7±12.8) years old on average,235 male(78.1%) and 66 female(21.9%).Chronic liver diseases mainly consisted of hepatitis B and alcoholic liver diseases(79.1%).All patients were divided into the DILI group(n=66,21.9%) and nonDILI group(n=235,78.1%).As for the clinical features,the levels of total bilirubin,aspartate transaminase(AST),alamine aminotransferase(ALT),alkaline phosphatase,γ-glutamyltransferase,total cholesterol,total bile acid and the proportion of progression to acute-on-chronic liver failure(ACLF) in the the DILI group were significantly higher than those the non-DILI group(all P<0.05).The coagulation function in the DILI group was worse than that in the non-DILI group(P<0.05).The length of hospital stay,28-d and 90-d allcause mortality rates in the DILI group were significantly higher compared with those in the non-DILI group(all P<0.05).In the DILI group,the types of drugs for liver injury mainly included Chinese herbal medicines(33.3%),antipyretic and analgesic drugs(31.8%),and the remaining drugs were antibiotics,lipid-lowering drugs or other unknown drugs.Conclusions The clinical features of AE-CLD caused by DILI and non-DILI factors differ.Compared with non-DILI factors,patients with AE-CLD induced by DILI factors have longer length of hospital stay,higher short-term mortality rate and worse clinical prognosis.The drugs that induce AECLD primarily include Chinese herbal medicine,antipyretic analgesics,antibiotics and lipid-lowering drugs.

关 键 词：慢性肝病急性加重 药物性肝损伤 临床特征 预后 

分 类 号：R575[医药卫生—消化系统]