162例药物性肝损伤患者分析  

Analysis of 162 cases of drug-induced liver injury

作　　者：汪涛 王学伟[1] 蒋元烨[1] 曹勤[1] 季光 WANG Tao;WANG Xue-wei;JIANG Yuan-ye;CAO Qin;JI Guang(Department of Gastroenterology,Putuo Hospital Affiliatedto Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China;Institute of Spleen and Stomach Diseases,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属普陀医院消化内科,200062 [2]上海中医药大学附属龙华医院脾胃病研究所

出　　处：《肝脏》2021年第3期243-246,共4页Chinese Hepatology

基　　金：国家自然科学基金青年项目(81703879);上海市卫健委临床研究专项(201840377;201940449);普陀区科委自主创新项目(ptkwws201813);上海市普陀区卫生系统自主创新科研资助项目(ptkwws201806)。

摘　　要：目的探讨药物性肝损伤(DILI)患者的用药情况及临床特征。方法上海中医药大学附属普陀医院2018年至2019年收治的DILI患者162例,收集既往使用药物,临床特征、实验室指标等临床数据并进行统计学分析。结果162例DILI患者中,男性60例(37%),女性102例(63%),以40~80岁居多,占141例(87%)。在引起DILI的药物中,中成药及中药汤剂占据首位,其中以首乌、雷公藤、栀子、骨康胶囊及仙灵骨葆胶囊居多。导致肝损伤的西药以心血管系统、抗肿瘤药及结核药物应用居多。162例患者中,乏力117例(72.2%),纳差86例(53.1%),尿黄67例(41.4%)。DILI以肝细胞损伤型最为多见,严重程度分级以1级肝损伤最常见,为112例(69.1%),肝细胞损伤型、胆汁淤积型及混合型患者的ALT、AST、ALP及GGT水平为318.50(177.50-724.00)U/L比117.50(67.00-231.50)U/L比321.00(187.75-747.75)U/L,223.50(118.75-490.75)U/L比132.50(69.00-206.75)U/L比224.00(123.94-670.00)U/L,190.00(122.00-281.75)U/L比289.50(263.00-507.00)U/L比347.00(249.00-560.5)U/L,164.50(89.50-242.25)U/L比309.00(143.50-506.00)U/L比283.00(191.50-574.00)U/L,差异具有统计学意义(均P<0.05)。中药导致的DILI患者的ALT、AST、AKP、TBil及住院天数明显高于西药组为423.00(238.00-728.50)U/L比190.00(97.00-311.00)U/L,345.00(151.25-613.75)U/L比139.00(82.65-223.00)U/L,274.50(207.75-355.25)U/L比220.00(126.00-306.00)U/L,66.5(19.25-114.75)μmol/L比17.00(11.00-33.00)μmol/L,20(15-24.75)比13.00(9.00-17.00),差异均有统计学意义(均P<0.05)。结论DILI以中老年女性较多;乏力为DILI患者最明显的临床表现,无论是草药还是西药介导的DILI,肝细胞损伤型居多;与西药相比,中药更能引起肝损伤。Objective To explore the medication situation and clinical characteristics of patients with drug-induced liver injury(DILI),to provide auxiliary judgment for clinicians.Methods The general information of 162 patients with DILI admitted in our hospital from2018 to 2019 was collected,and clinical data including drugs previously used,clinical characteristics,laboratory data,and statistical analysis.Results Of the 162 patients with DILI,60 were male(37%)and 102 were female(63%),with the majority in the 40-80 age group,accounting for 141(87%).Among the drugs that caused DILI,we found that Chinese patent medicines and Chinese medicine decoctions occupied the first place,among which Shouwu,Tripterygium wilfordii,Zongzi,Gukang capsules,and Xianling Guzhen capsules were the majority.Antitumor drugs and tuberculosis drugs were mostly used.Among 162 patients,fatigue was the most common in 117 cases(72.2%),followed by anorexia in 86 cases(53.1%)and urinary yellow in 67 cases(41.4%).Hepatocyte injury type was the most common type of DILI,and grade 1 liver injury was the most,accounting for 112 cases(69.1%).The differences in ALT,AST,ALP,andγ-GT levels among the three types of hepatocyte injury,cholestasis,and mixed types were statistically significant[318.50(177.50-724.00)U/L vs 117.50(67.00-231.50)U/L vs 321.00(187.75-747.75)U/L,P=0.000;223.50(118.75-490.75)U/L vs 132.50(69.00-206.75)U/L vs 224.00(123.94-670.00)U/L,P=0.043;190.00(122.00-281.75)U/L vs 289.50(263.00-507.00)U/L vs 347.00(249.00-560.5)U/L,P=0.000;164.50(89.50-242.25)U/L vs 309.00(143.50-506.00)U/L vs 283.00(191.50-574.00)U/L,P=0.000].In addition,the ALT,AST,APK,TB,and length of hospital stay of DILI patients caused by Chinese medicine were significantly higher than those of western medicine group[423.00(238.00-728.50)U/L vs 190.00(97.00-311.00)U/L,P=0.000;345.00(151.25-613.75)U/L vs 139.00(82.65-223.00)U/L,P=0.000;274.50(207.75-355.25)U/L vs 220.00(126.00-306.00)U/L,P=0.009;66.5(19.25-114.75)μmol/L vs 17.00(11.00-33.00)μmol/L,P=0.000;20(15-24.75)vs 13.00(9.00

关 键 词：药物性肝损伤 用药史 临床表现 

分 类 号：R575[医药卫生—消化系统]