药物性肝损伤202例临床特征分析  

Clinical analysis of 202 patients with drug-induced liver injury

作　　者：许波 王勤英[1] Xu Bo;Wang Qinying(Department of Infectious Diseases,First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,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：《中国基层医药》2023年第8期1189-1193,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨药物性肝损伤(DILI)的临床特征,为DILI的防治提供依据。方法收集山西医科大学第一医院2018年11月至2021年11月住院治疗的资料完整的DILI患者202例的临床资料,对患者性别、年龄、服用或接触的药物种类和名称、临床特征、自身抗体、肝功能等相关指标进行统计学分析。结果202例DILI患者中,男77例(38.1%),女125例(61.9%),年龄分布以>40~60岁(55.0%)为主。肝细胞型141例(69.8%),胆汁淤积型27例(13.4%),混合型34例(16.8%),不同临床分型间丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、γ-谷氨酰氨基转移酶、碱性磷酸酶、凝血酶原时间、国际标准化比值、凝血酶原活动度差异均有统计学意义(H=91.43、58.65、9.25、32.69、9.56、8.19、9.40,均P<0.05)。202例DILI患者中,重度肝损伤最多(40.6%),不同临床分型疾病严重程度差异无统计学意义(P=0.789)。引起DILI的药物种类占前3位的分别是中药[52.0%(105/202)]、抗肿瘤药[6.4%(13/202)]、抗精神病药[5.9%(12/202)]。202例DILI患者自身抗体检出率为29.7%(60/202)。结论DILI临床表现缺乏特异性,致病药物种类较多,临床医师应对重点人群加强肝功能监测。混合型患者肝功能衰竭比例高,应引起重视。DILI患者肝病相关抗体阳性时,应高度警惕是否存在自身免疫性肝病的可能。Objective To investigate the clinical characteristics of drug-induced liver injury and provide a theoretical basis for the prevention and treatment of drug-induced liver injury.Methods The clinical data of 202 patients with complete information on drug-induced liver injury who received treatment in First Hospital of Shanxi Medical University from November 2018 to November 2021 were collected.The information including gender,age,type and name of drugs taken or exposed,clinical characteristics,autoantibodies,and liver function was statistically analyzed.Results Among the 202 patients with drug-induced liver injury,77 patients(38.1%)were male and 125 patients(61.9%)were female.Age distribution was mainly at>40-60 years.There were 141 cases(69.8%)of hepatocellular type,27 cases(13.4%)of cholestatic type,and 34 cases(16.8%)of mixed type.There were statistically significant differences in alanine aminotransferase,aspartate aminotransferase,γ-glutamine transferase,alkaline phosphatase,prothrombin time,international standardized ratio,and prothrombin activity between different clinical types(H=91.43,58.65,9.25,32.69,9.56,8.19,9.40,all P<0.05).Among the 202 patients with drug-induced liver injury,severe liver injury occurred in the largest proportion of cases(40.6%).There was no significant difference in the disease severity between different clinical types(P=0.789).The top three types of drugs causing liver injury were traditional Chinese medicine[52.0%(105/202)],antineoplastic drugs[6.4%(13/202)],and antipsychotics[5.9%(12/202)].The detection rate of autoantibodies in 202 patients with drug-induced liver injury was 29.7%(60/202).Conclusion Drug-induced liver injury lacks specificity in clinical manifestations.A wide variety of drugs can cause liver injury.Clinicians should strengthen liver function monitoring in key populations.The proportion of patients with mixed-type liver failure is high,which should be taken seriously.When patients with drug-induced liver injury are positive for liver disease-related antibodies,cl

关 键 词：化学性与药物性肝损伤 疾病特征 丙氨酸转氨酶 天冬氨酸氨基转移酶类 Γ-谷氨酰转移酶 碱性磷酸酶 凝血酶原时间 自身抗体 中草药 抗肿瘤药 抗精神病药 

分 类 号：R575[医药卫生—消化系统]