290例药物性肝损伤患者临床特征分析

目的探讨药物性肝损伤(DILI)患者的病因构成、临床特点和预后情况。方法2013年1月~2016年2月我科诊治的300例DILI患者,根据Roussel Uclaf因果关系(RUCAM)量表评估。结果经RUCAM量表评分诊断为DILI患者290例;引起DILI的药物为中药,占42.8%,抗菌药和抗结核药物分别占9.3%和7.6%;基础疾病以胃炎最为多见,占18.6%;肝细胞型占54.5%;中度肝损伤占37.6%;肝衰竭发生率为5.5%,治疗有效率为93.8%,死亡4例。结论应用RUCAM量表有助于DILI的规范化诊断,中药导致的肝损伤不可忽视,大部分DILI患者临床预后较好,少数发生急性肝衰竭,预后差,应引起高度重视。

Clinical feature of 290 patients with drug-induced liver injury

Objective The purpose of this study was to investigate the clinical feature of 290 patients with drug-induced liver injury (DILI). Methods 300 hospitalized patients were admitted in our Department of Infectious Diseases from January 2013 through February 2016, and 290 were diagnosed as DILI by the Roussel Uclaf causality assessment (RUCAM) scale. Results The common agents were traditional Chinese medicine, accounting for 42.8%, antibiotics for 9.3% and anti-tuberculosis medicines for 7.6%; the elevated serum alanine aminotransferase levels was the most obvious manifestation; the underlying diseases were chronic gastritis in 18.6%, the hepatocellular injury type accounted for 54.5% and the moderate DILI accounted for 37.6%; 16 patients 5.5% progressed to liver failure and four died; the total treatment effective rate was 93.8%. Conclusion The RUCAM scale is helpful for the standardization of DILI diagnosis. The traditional Chinese medicines account for the highest proportion of liver injuries in our series, and the hepatocellular damage is the most common type. Most DILI patients have a good clinical prognosis. Attentions should be paid to patients with acute liver failure, which is associated with poor prognosis.