中国药物警戒 ›› 2019, Vol. 16 ›› Issue (5): 293-296.

• 安全性评价与合理用药 • 上一篇    下一篇

我院371例药物性肝损伤的临床特征及预后分析

杨雯, 王琦*   

  1. 山西医科大学第二医院消化内科,山西 太原 030000
  • 收稿日期:2019-03-25 修回日期:2019-06-11 出版日期:2019-05-20 发布日期:2019-06-11
  • 通讯作者: 王琦,女,硕士,教授·硕导,消化内科。E-mail：wangqiqi72000@163.com
  • 作者简介:杨雯, 女,在读硕士,药物性肝损伤。

Analysis of the Clinical Characteristics and Prognosis of 371 Cases of Drug-Induced Liver Injury in Our Hospital

YANG Wen, WANG Qi*   

  1. Department of Gastroenterology,the Second Hospital of Shanxi Medical University,Shanxi Taiyuan 030000, China
  • Received:2019-03-25 Revised:2019-06-11 Online:2019-05-20 Published:2019-06-11

PDF (PC)

169

摘要： 目的 探讨药物性肝损伤的临床特征及预后影响因素。方法 回顾性分析本院近4年收治的371例药物性肝损伤患者的性别、年龄、基础疾病、饮酒史、肝损伤药物和实验室检查。结果 从2015年至2018年,我院DILI患者在肝病住院患者中的年度构成比逐渐增高,其中男女比例为1：1.25,年龄主要集中在40~69岁（221例,59.57%）;引起药物性肝损伤的主要药物有中药（33.25%）、抗肿瘤药（17.63%）、抗微生物药（14.61%）,其中单药环磷酰胺（5.54%）最多;74.39%有临床症状,主要为乏力（56.33%）、食欲下降（55.53%）、黄疸（36.93%）;临床类型以肝细胞损伤型为主（69.54%）,ALT、AST升高易出现肝细胞损伤型（P=0.000）,年龄大者、ALP高者易出现胆汁淤积型（P分别为0.01、0.000）,有肿瘤病史者、白蛋白高者易出现混合型（P 分别为0.01、0.000）;85.98%的DILI预后好,14.02%预后差,预后的危险因素为年龄（OR=4.12,P =0.00）、基础肝病（OR=2.54,P =0.02）、总胆红素（OR=1.01,P =0.00）、胆汁淤积型（OR=4.04,P =0.01）,危险程度为年龄>胆汁淤积型>基础肝病>总胆红素,白蛋白为保护因素（OR=0.21,P =0.00）。结论 多种药物可引起DILI,其发病呈上升趋势,临床症状无特异,临床分型以肝细胞损伤型为主,多数预后良好,少数预后差,年龄大、有基础肝病、TBIL高、胆汁淤积型的患者预后不良的风险增加,白蛋白高有助于DILI的好转。

关键词: 药物性肝损伤, 临床特征, 预后, 影响因素

Abstract: Objective To investigate the clinical characteristics and the influence factors of prognosis of drug-induced liver injury. Methods To retrospectively analyze 371 patients' sex, age, underlying disease, drinking history, liver injury drugs, and laboratory inspection with drug-induced liver injury in our hospital in the past 4 years．Results From 2015 to 2018, the annual composition of patients with DILI in hospitalized patients with liver disease was gradually increasing in our hospital. The ratio of male to female was 1:1.25, and the age mainly concentrated on 40~69 years old (59.57%). Common medicines causing drug-induced liver injury were traditional Chinese medicines(33.25%), anti-tumor drugs (17.63%), and anti-microbial drugs (14.61%), of which single-agent cyclophosphamide (5.54%) was the most. 74.39% of patients had clinical symptoms, mainly including fatigue (56.33%), loss of appetite (55.53%), and jaundice(36.93%).The clinical type is mainly hepatocyte injury type(69.54%). Those patients with ALT, AST increased were prone to hepatocyte injury (P =0.000), the older and those with high ALP were prone to cholestasis (P =0.01, P =0.000), and those with a history of tumors and high albumin were prone to mixed type(P =0.01, P =0.000). 85.98% of patients with DILI had a good prognosis, but 14.01% had a poor prognosis. The risk factors of prognosis were age (OR=4.12, P =0.00), basic liver disease (OR=2.54, P =0.02), total bilirubin (OR=1.01, P =0.00) and cholestasis type (OR=4.04, P =0.01) so that the degree of risk was age> cholestasis>basic liver disease>total bilirubin. Albumin was the protective factor of prognosis(OR=0.21, P =0.00). Conclusion A number of drugs could cause drug-induced liver injury. The morbidity was gradually ascending. The clinical symptoms were not specific and clinical type was mainly hepatocyte injury type. Most patients had a good prognosis, but a minority of patients had a poor prognosis. Patients who are older, with basic liver disease, high TBIL, and clinical type of cholestasis had an increased risk of poor prognosis, while higher albumin was good for patients.

Key words: drug-induced liver injury, clinical characteristics, prognosis, influence factors

中图分类号: