摘要
目的初步探讨药物性肝损伤(DILI)慢性化的临床类型及主要特点。方法筛选2011年1月-2013年12月在首都医科大学附属北京佑安医院住院诊断为DILI的病例,对其中的84例慢性DILI进行回顾性分析。所有入选病例均填写病例报告表,数据录入数据库,包括人口学特征、基础疾病、用药种类、主要症状和体征、实验室检查等。结果 84例患者中女性63例,占75.0%。根据病情发展和肝功能的恢复过程,可将DILI的慢性化过程分为6种临床类型,其中64例(76.2%)为反复发作型,4例(4.8%)为迁延不愈型,4例(4.8%)为反复波动型,6例(7.1%)为慢性胆汁淤积型,5例(6.0%)为快速进展至肝硬化型,1例(1.2%)为药物诱导的自身免疫性肝炎型。84例患者中56例(66.7%)患者存在基础疾病;由单一药物引起者有51例(60.7%),主要为中药(47.0%)、解热镇痛药(10.6%)和抗结核药(9.1%);肝损伤类型中肝细胞损伤型52例(61.9%)、胆汁淤积型8例(9.5%)、混合型5例(6.0%);肝脏生化学检查异常19例(22.6%)。结论 DILI的慢性化可分为6种临床类型,最常见的是反复发作型,其他还包括迁延不愈、反复波动、慢性胆汁淤积、快速进展至肝硬化和药物诱导的自身免疫性肝炎。
Objective To investigate the clinical types and features of chronicity of drug- induced liver injury（ DILI）. Methods The patients who were diagnosed with DILI in Beijing You An Hospital,Capital Medical University from January 2011 to December 2013 were screened,and a retrospective analysis was performed for 84 patients with chronic DILI. The case report form was filled out for each patient,and the data were entered into a database,including demographic features,underlying diseases,types of drugs,cardinal symptoms and signs,and laboratory examinations. Results Of all patients,63（ 75. 0%） were female. The chronicity of DILI could be divided into six clinical types according to disease progression and recovery of liver function; of all patients,64（ 76. 2%） had a recurrent type,4（ 4. 8%）had a delayed recovery type,4（ 4. 8%） had a recurrent fluctuation type,6（ 7. 1%） had a chronic cholestasis type,5（ 6. 0%） had a type of rapid progression to liver cirrhosis,and 1（ 1. 2%） had a type of drug- induced autoimmune hepatitis. Among all the 84 patients,56（ 66. 7%） had underlying diseases; 51（ 60. 7%） had DILI induced by a single drug,mainly traditional Chinese medicine（ 47. 0%）,antipyretics and analgesics（ 10. 6%）,and antitubercular agents（ 9. 1%）; as for the type of liver injury,52（ 61. 9%） had hepatocyte injury,8（ 9. 5%） had cholestasis,and 5（ 6. 0%） had a mixed type. Liver biochemistries showed abnormal results in 19 patients（ 22. 6%）. Conclusion The chronicity of DILI can be divided into six clinical types,of which the most common type is the recurrent type,and the other clinical types include delayed recovery type,recurrent fluctuation type,chronic cholestasis type,rapid progression to liver cirrhosis,and drug- induced autoimmune hepatitis.
出处
《临床肝胆病杂志》
CAS
2016年第12期2356-2359,共4页
Journal of Clinical Hepatology
基金
中国肝炎防治基金会天晴肝病研究基金(TQGB20140052)
首都临床特色应用研究专项(Z121107001012086)
佑安肝病艾滋病基金(YNKT20160016)
关键词
药物性肝损伤
慢性病
drug-induced liver injury
chronicity disease
