441例药物性肝损伤患者临床和肝组织病理学特征分析

doi:10.3969/j.issn.1672-5069.2015.02.017

实用肝脏病杂志 ›› 2015, Vol. 18 ›› Issue (3): 286-289.doi: 10.3969/j.issn.1672-5069.2015.02.017

441例药物性肝损伤患者临床和肝组织病理学特征分析

姚云洁, 刘鸿凌, 朱冰, 刘婉姝, 臧红, 李晨, 李亚斐, 辛绍杰

400038重庆市第三军医大学军事预防医学院（姚云洁,李亚斐）; 重庆市渝北区人民医院感染病科（姚云洁）; 北京解放军第302医院肝衰竭诊疗与研究中心（刘鸿凌,刘婉姝,游绍莉,朱冰,辛绍杰）

收稿日期:2015-01-06 出版日期:2015-05-10 发布日期:2016-02-19
通讯作者: 李亚斐,E-mail:liyafei2008@hotmail.com E-mail:lhl7125@sina.com
作者简介:姚云洁,女, 40岁,医学硕士,副主任医师。主要从事慢性肝炎/肝硬化的诊治研究。E-mail：891426884@qq.com 共同刘鸿凌,男,43岁,医学博士,副主任医师。主要从事重型肝炎/肝衰竭的诊治研究。E-mail:lhl7125@sina.com

Analysis of clinical features and pathological change in 441 patients with drug-induced liver injuries

Yao Yunjie, Liu Hongling, Zhu Bing, et al.

Military School of Preventive Medicine,Third Military Medical University, Chongqing 400038,China

Received:2015-01-06 Online:2015-05-10 Published:2016-02-19

摘要/Abstract

摘要： 目的分析近年来药物性肝损伤患者的临床特点和肝组织病理学特征。方法收集2010年1月1日至2014年5月收治的441例药物性肝损伤患者的用药特点和时间、临床表现、实验室检查、病理活检及临床病程等资料,进行回顾性分析。结果中(草)药和西药所致肝损伤分别为176例（39.91%）和210例（47.62%）,其它原因致肝损伤为55例（12.47%）;从临床分型看,肝细胞型178例（40.36%）,其次是胆汁淤积型132例（29.93%）和混合型131例（29.71%）;中药和西药所致药物性肝损伤在病理类型和实验室检查方面无显著性差异（P>0.05）;在临床症状方面,中药发生皮疹的比例显著低于西药（1.1%对5.2%,P<0.05）,而脾脏肿大比例显著高于西药（78.4%对46.2%,P<0.05）;中药诱发肝损伤相对西药用药时间较长（P<0.05）;本组总体治愈好转率为94.56%。结论药物性肝损伤的发生与多种药物及用药时间密切相关。

关键词: 药物性肝损伤, 临床特点, 病理改变

Abstract: Objective To explore the clinical features and pathological changes in patients with drug-induced liver injury（DILI） in recent years. Methods Data of 441 patients with DILI from January 2010 to May 2014,including the medication courses,clinical manifestations, lab results,pathological findings and disease courses, were retrospectively analyzed. Results The numbers of patients with traditional Chinese medicine（TCM）-induced liver injury and western medicine-induced liver injury were 176 （39.91%） and 210 （47.62%）,respectively;All patients were divided into three clinical types:e.g. 178（40.36%） with hepatocyte DILI,132（29.93%） with cholestatic DILI and 131（29.71%） with mixed DILI;No significant difference was found in histological changes and laboratory indexes between TCM-and western medicine-induced liver injuries（P>0.05）;However,TCM-induced patients had a lower incidences of erythra than in patients receiving western medicine（1.1% vs. 5.2%,P<0.05）,but had a higher incidences of splenomegaly（78.4% vs. 46.2%,P<0.05）;In addition,it took longer to develop liver injuries for TCM-induced patients（P<0.05）;The recovery rate of all the DILI patients in this series was 94.56%. Conclusion A variety of medicines is closely involved in reducing DILI in clinical practice,which warrants further studies.

Key words: Drug-induced liver injury, Clinical feature, Histological change

姚云洁, 刘鸿凌, 朱冰, 刘婉姝, 臧红, 李晨, 李亚斐, 辛绍杰. 441例药物性肝损伤患者临床和肝组织病理学特征分析[J]. 实用肝脏病杂志, 2015, 18(3): 286-289.

Yao Yunjie, Liu Hongling, Zhu Bing, et al.. Analysis of clinical features and pathological change in 441 patients with drug-induced liver injuries[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2015, 18(3): 286-289.

参考文献

[1] Danan G,Benichou C.Causality assessment of adverse reactions to drugs IA novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries. J Clin Epidemiol,1993,46（11）:1323-1330.
[2] 中华医学会消化病学分会肝胆疾病协作组.急性药物性肝损伤诊治建议（草案）. 中华消化杂志,2007,27（11）：765-767.
[3] Chalasani NP,Hayashi PH,Bonkovsky HL,et al. ACG Clinical Guideline:the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol,2014,109（7）:950-966.
[4] 刘蕾,张晓岚. 药物性肝损伤诊断与防治进展. 临床肝胆病杂志,2012,28（6）:477-481.
[5] 胡锡琪. 药物性肝损伤组织病理学评分探讨. 肝脏,2010,15:317-319.
[6] 于乐成,陈成伟. ACG特异质性药物性肝损伤临床诊治指南解读. 肝脏,2014,19（8）:570-574.
[7] 陈成伟.药物性肝损害诊断标准的评价.诊断学理论与实践,2009,8（2）:121-124.
[8] 王吉耀,郭津生. 药物性肝病//陈灏珠. 实用内科学,12版,北京:人民卫生出版社,2005:2000-2004.
[9] Michael DL,John JP,Jayant A. Drug-induced liver injury. Mayo Clin Proc,2014,89（1）:95-106.
[10] Stefan D,Hamilton JP. Drug-induced iiver injury. US Gastroenterol Hepatol Rev,2010,6:73-80.
[11] Tillmann HL,Rockey DC. Improved prediction of the need for liver transplantation in patients with drug-induced liver injury? Gastroenterology,2014,147（6）:1441.
[12] Al-Halawani MZ,Thawabi M,Asslo F,et al. Losartan-induced ischemic hepatocellular hepatotoxicity:A case report and literature review. J Family Med Prim Care,2014,3（3）:272-274.
[13] Nicoletti NF,Rodrigues-Junior V,Santos AA Jr,et al. Protective effects of resveratrol on hepatotoxicity induced by isoniazid and rifampicin via SIRT1 modulation. J Nat Prod, 2014,77（10）:2190-2195.
[14] Wu Chou AI,Lu ML,Shen WW. Hepatotoxicity induced by clozapine:a case report and review of literature. Neuropsychiatr Dis Treat,2014,10:1585-1587.
[15] Wehling M. Non-steroidal anti-inflammatory drug use in chronic pain conditions with special emphasis on the elderly and patients with relevant comorbidities:management and mitigation of risks and adverse effects. Eur J Clin Pharmacol,2014,70（10）:1159-1172.
[16] Devarbhavi H,Andrade RJ. Drug-induced liver injury due to antimicrobials,central nervous system agents,and nonsteroidal anti-inflammatory drugs. Semin Liver Dis,2014,34（2）:246-251.
[17] Huang YS. Genetic polymorphisms of drug-metabolizing enzymes and the susceptibility to antituberculosis drug-induced liver injury. Expert Opin Drug Metab Toxicol,2007,3:1-8.
[18] Daly AK,Aithal GP,Leathart JB,et al. Genetic susceptibility to diclofenac-induced hepatotoxicity:contribution of UGT2B7,CYP2C8,and ABCC2 genotypes. Gastroenterology,2007,132:272-281.
[19] Andrade RJ,Lucena MI,Alonso A,et al. HLA class II genotype influences the type of liver injury in drug-induced idiosyncratic liver disease. Hepatology,2004,39:1603-1612.
[20] Daly AK,Donaldson PT,Bhatnagar P,et al. HLA-B*5701 genotype is a major determinant of drug-induced liver injury due to flucloxacillin. Nat Genet, 2009,41:816-829.

441例药物性肝损伤患者临床和肝组织病理学特征分析

Analysis of clinical features and pathological change in 441 patients with drug-induced liver injuries

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