摘要
目的:分析药物性肝损伤(drug-induced liver injury,DILI)的临床特征,探讨影响其预后的危险因素.方法:回顾性总结西安交通大学第一附属医院、西安交通大学第二附属医院、西京医院西安三所医院近5年的572例药物性肝损伤患者的临床资料,分析其性别、年龄、既往史、用药时间、临床表现、临床分型、用药史、生化指标、用药方式、治疗方法等临床特征,及其对预后的影响.结果:(1)纳入本研究的DILI患者共572例,男性280例(48.95%),女性292例(51.05%),平均年龄45.56岁±15.11岁;(2)既往有吸烟史的226例,有饮酒史的205例,有过敏史的115例,有基础肝病史的155例;肝损伤发生时间绝大多数<8 wk,为490例;临床表现主要为皮肤巩膜黄染或尿色加深占59.44%,乏力占57.52%,纳差占55.42%;临床分型肝细胞型为402例,胆汁淤积型为62例,混合型为53例;导致DILI的前3类药物依次为中药299例、抗结核药71例、抗微生物用药48例;用药方式为口服用药533例,静脉注射20例,外用给药14例;预后情况治愈194例,好转323例,未愈39例,死亡16例;(3)影响药物性肝损伤预后的因素有用药时间、临床分型、用药种类、用药方式及总胆红素指标.其中总胆红素为DILI的独立危险因素.结论:药物性肝损伤的临床表现缺乏特异性,致病药物种类较多,中药为最常见的原因,影响DILI预后的因素较多,总胆红素为独立危险因素.
AIM： To analyze the clinical features of drug- induced liver injury （DILI）, and discuss the risk factors affecting its prognosis. METHODS： Clinical data for 572 patients with DILI hospitalized at the First Affiliated Hospital of Xi＇an Jiaotong University, the Second Affiliated Hospital of Xi＇an Jiaotong University and Xijing Hospital from 2010 to 2014 were retrospectively analyzed. Gender, age, underlying disease, medication time, clinical manifestation, clinical classification, type of drugs, laboratory tests, ways of medication, treatments and prognosis were analyzed to explore the risk factors affecting the prognosis.RESULTS： A total of 572 patients were involved, including 280 （48.95%） males and 292 （51.05%） females, and their average age was 45.56 ＋ 15.11 years. Most cases of DILI occurred in less than 8 weeks of medication. Main clinical manifestations were jaundice （59.44%）, fatigue （57.52%）, and poor appetite （55.54%）. Four hundred and two （70.28%） cases were classified as hepatocellular type, 62 （10.84%） cases as cholestasis type and 53 （9.27%） as mixed type. The top three most common types of drugs that induced DILI were Chinese herbs, antituberculotics and antimicrobials.As for the prognosis, 194 cases were cured, 323 cases improved well, 39 cases showed no significant improvement, and 16 cases died. Factors influencing prognosis of DILI were medication time, clinical classification, type of drugs and index of total bilirubin, with total bilirubin being an independent risk factor for DILI.CONCLUSION： Clinical manifestations of drug-induced liver injury are non-specific. The most common cause is Chinese medicine. There are many factors influencing DILI, with total bilirubin being the independent risk factor.
出处
《世界华人消化杂志》
CAS
2016年第8期1257-1263,共7页
World Chinese Journal of Digestology
关键词
药物性肝损伤
临床特点
预后分析
危险因素
Drug-induced liver injury
Clinical features
Prognostic analysis
Risk factors
