60例药物性肝损伤患者临床特征和转归分析*

doi:10.3969/j.issn.1672-5069.2022.05.011

摘要/Abstract

摘要： 目的分析总结药物性肝损伤(DILI)患者临床特征和转归情况。方法 2018年8月～2021年12月我院诊治的DILI患者60例,收集临床资料,包括应用药物、发病时间、临床病情和治疗时间,进行临床分型和病情分级。将临床症状体征完全消失或明显好转,肝功能指标恢复正常定义未痊愈,否则为未愈。结果本组60例DILI患者主要应用药物包括化学药物16例(26.7%),中草药13例(21.7%),抗生素类药物8例(13.3%),抗甲状腺机能亢进症药物7例(11.7%),降血脂类药物5例(8.3%),应用抗结核药4例(6.7%),抗精神类药物3例(5.0%),降血压药2例(3.3%)和保健品2例(3.3%);用药至发病2～118 d,其中≤1周发病19例(31.7%), 1周～3月发病24例(40.0%),>3月发病17例(28.3%);临床表现包括纳差13例(21.7%)、恶心呕吐13例(21.7%)、乏力12例(20.0%)、皮肤巩膜黄染13例(21.7%)、腹痛腹泻8例(13.3%)、皮肤瘙痒2例(11.7%),无明显症状25例(41.7%);本组DILI患者严重程度分级分别为1级42例(70.0%)、2级7例(11.7%)、3级6例(10.0%)、4级5例(8.3%),无5级病例;比较49例≤2级与11例≥3级DILI患者临床资料,发现两组年龄和性别无显著性统计学差异(P>0.05),而≥3级患者发病时间更短,治疗时间更长(P<0.05);本组54例DILI患者痊愈,6例未愈。未愈患者病情显著重于痊愈患者(P<0.05)。结论本组DILI患者的临床特点以消化症状最为多见,常引起DILI的药物包括化学药物、中草药、抗生素类、抗甲状腺功能亢进症药物和降血脂类药。临床未愈患者肝功能损伤程度更重,需要积极处理。

关键词: 药物性肝损伤, 中草药, 肝功能分级, 预后

Abstract: Objective The purpose of this study was to collect and summarize the clinical feature of patients with drug-induced liver injury (DILI), and to analyze the suspected medicines, clinical characteristics and clinical outcome of patients with DILI. Methods 60 patients with DILI were encountered in our hospital between August 2018 and December 2021,and we collect the clinical materials, including the suspected medicines, episode times, disease severities and treatment periods. The clinical categories and disease grades were determined. The outcomes included recovery, with clinical symptoms and signs disappeared and liver function tests back to normal, and non-recovery. Results The main medicines in the 60 patients with DILI were chemical medicines in 16 cases(26.7%), Chinese herbal medicine in 13 cases(21.7%), antibiotics in 8 cases(13.3%), antithyroid medicines in 7 cases(11.7%), hypolipidemic drugs in 5 cases (8.3%), anti-tuberculosis drugs in 4 cases (6.7%), psychotropic drugs in 3 cases (5.0%), antihypertensive drugs in 2 cases (3.3%) and health products in 2 cases (3.3%); the episode time ranged from 2 to 118 days, and within one week in 19 cases (31.7%), one week to three months in 24 cases (40.0%) and longer than three months in 17 cases(28.3%); the clinical manifestations included anorexia in 13 cases (21.7%), nausea and vomiting in 13 cases (21.7%), fatigue in 12 cases (20.0%), jaundice in 13 cases (21.7%), abdominal pain and diarrhea in 8 cases (13.3%), pruritus in 2 cases (11.7%), and without obvious symptoms in 25 cases (41.7%); the disease severities included grade one in 42 cases (70.0%), grade two in 7 cases(11.7%), grade three in 6 cases (10.0%) and grade four in 5 cases (8.3%), without grade five in our series; the ages and gender between 49 patients with ≤grade 2 and 11 patients with ≥ grade 3 were not significantly different (P>0.05), while the episode time in patients with ≥grade 3 were shorter and the hospitalization stay longer (P<0.05); 54 patients recovered and 6 patients didn’t in our series. Conclusion The most common clinical symptoms in our patients with DILI are digestive system-related, and the common medicines which lead to DILI include chemical medicines, Chinese herbal medicines, antibiotics, antithyroid drugs, hypolipidemic drugs and so on. The patients with poor clinical outcome tend to have severe liver function injuries with coagulation function tests deteriorated, and need careful management in clinical practice.

Key words: Drug-induced liver injury, Chinese herbal medicine, Liver function grades, Prognosis

刘艳, 沈宇, 张茜. 60例药物性肝损伤患者临床特征和转归分析^*[J]. 实用肝脏病杂志, 2022, 25(5): 649-652.

Liu Yan, Shen Yu,Zhang Qian. Characteristics and clinical outcomes of 60 patients with drug-induced liver injury[J]. Journal of Practical Hepatology, 2022, 25(5): 649-652.

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60例药物性肝损伤患者临床特征和转归分析^*

Characteristics and clinical outcomes of 60 patients with drug-induced liver injury

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