实用肝脏病杂志 ›› 2010, Vol. 13 ›› Issue (1): 48-50.

• 短篇论著 • 上一篇    下一篇

132例药物性肝损伤临床分析

李平, 谢同柄   

  1. 239300 安徽省天长市人民医院感染病科
  • 收稿日期:2009-10-23 出版日期:2010-02-10 发布日期:2016-04-18
  • 作者简介:李平 男,46岁,副主任医师。主要从事感染性疾病与肝病的临床工作。E-mail:lp13955079078@sina.com

Clinical analysis of 132 patients with drug-induced liver damage

LI Ping, XIE Tongbing.   

  1. Department of Infectious Disease,Tianchang People′s Hospital,Anhui province,239300
  • Received:2009-10-23 Online:2010-02-10 Published:2016-04-18

摘要: 目的 分析近年来药物性肝损伤的病因、临床特点、诊断及预后,以提高临床医生对本病的认识。方法 根据Maria的“临床诊断量表(CDS)”对2003年4月至2009年4月间因药物性肝损伤而住入我院的病例进行评分,对≥10分的132例患者的病因进行回顾性分析和临床分型。结果 引起肝损伤的药物有15类50余种,中草药、抗结核药、抗肿瘤药物和抗菌药物共占72.7%。潜伏期在5天~356天之间, 在4周内、8周内和12周内发生肝损伤的比例分别为61.4%、84.9%和91.7%。肝细胞损伤型占78.8%,淤胆型占13.6%, 混合型占7.6%。27例无临床症状和体征仅有实验室检测异常(20.5%),而有临床症状105例(79.5%),主要表现为乏力(64.4%)、纳差(53.0%)、尿黄(41.7%)。104例肝细胞损伤型患者中,在停药2月内肝功能均恢复正常,在停药30天内均有ALT降低>50%,预后好。结论 中草药、抗结核药、抗肿瘤药物和抗菌药物是引起药物性肝损伤的主要病因,绝大多数发生在12周内,用药时间越长,发生肝损伤的几率越高。药物性肝损伤主要临床类型为肝细胞损伤型,其临床特点与各类急、慢性肝胆疾病相似,无特异性,预后好。

关键词: 药物性肝损伤, 病因, 临床特点

Abstract: Objective To analyse causes,clinical features,diagnosis and prognosis of drug-induced liver damage in recent years in order to improve clinical doctors’ understanding of this problem. Methods we scored inpatients with drug-induced liver damage from April 2003 to April 2009 in our hospital according to Maria“clinical diagnosis scales”,and causes of 132 patients among whole patients who scored greater than or equal to 10 were retrospectively analyzed and clinically classified. Result There were more than fifty kinds of drugs from fifteen groups that could induce liver damage. Among these drugs 72.7 percent were Chinese traditional medicine,antitubercular drug,antineoplastic drug and Antibiotics,which were the major medicine that caused liver damage. Incubation period of 5 day to 356 day,the percentage of liver damage happened in fourth week,eighth week,and twelfth week was 61.4 percent,84.9 percent and 91.7 percent respectively.78.8 percent(of the total cases) were hepatocellular injury type,13.6 percent cholestatic type,and 7.6 percent mixed type. There were 27 patients(20.5%) with no clinical symptom and objective sign but abnormal Lab findings. There were 105 patients(79.5%) with clinical symptom such as fatigue(64.4%),anorexia(53.0%),and colored urine(41.7%). Among 104 patients with liver damage,all had their ALT cut down more than 50 percent in 30 days and recovered their liver function in 2 months after discontinuation. Conclusion The main causes of drug-induced liver damage were Chinese traditional medicine,antitubercular drug,antineoplastic drug and Antibiotics. Mostly drug-induced liver damage occurred within 12 weeks,and he longer the drugs are used,the higher the probability of the liver damage occurs.The main damage type were hepatic cellullar damage,and its clinical feature were similar to each acute or chronic liver disease,without specificity,its prognosis were good.

Key words: Drug-induced liver damage, Cause, Clinical feature