药物性肝病79例回顾性分析

目的:分析药物性肝病的病因、临床表现,探讨影响预后的因素。方法:采用回顾性分析方法,分析79例药物性肝病的病因、临床表现、临床病理类型、治疗及预后。结果:引起药物性肝病的可能药物依次为抗肿瘤药15例(19%),抗结核药10例(13%),抗菌药10例(13%),免疫抑制剂9例(11%),非甾体类解热镇痛药9例(11%),甲状腺激素及抗甲状腺药6例(8%),性激素类4例(5%),中药4例(5%),口服降糖药3例(4%),调脂药3例(4%),抗癫痫药2例(3%),抗精神病药1例(1%),抗病毒药1例(1%),三醋吗啡1例(1%),黄热病疫苗1例(1%)。无任何临床表现29例(37%),纳差或呕吐38例(48%),发热24例(30%),皮疹或皮肤搔痒10例(13%),关节疼痛4例(5%)。黄疸30例(38%),肝或脾肿大12例(15%),腹水2例(2%),白陶土样大便1例(1%)。嗜酸性粒细胞增高11例(14%)。有药物过敏史者10例(13%)。病理类型:肝细胞损害型42例,胆汁淤积型8例,混合型29例。结论:药物性肝病的预后因子为年龄、基础疾病、以往发生过药物性肝病,早期诊断、早期治疗药物性肝病亟需引起重视。

Retrospective analysis of 79 cases of drug-induced liver disease

AIM: To investigate the etiology,clinic manifestation and possible factors affect prognosis. METHODS:A retrospective study of 79 cases of drug induced liver disease was performed in etiology,clinic manifestation,clinic pathologic types,therapy and prognosis. RESULTS:The agents which may cause druginduced liver disease are listed orderly as follows: antitumor agents 15 cases(19 %),antituberculous drugs 10 cases(13 %),antiseptics 10 cases(13 %),immunosuppressive drugs 9 cases((11 %)),non-steroidal anti-inflammatory drugs 9 cases((11 %),) thyroid hormone and antithyroid drugs 6 cases((8 %)),sex and anabolic steroids 4 cases(5 %),Chinese medicine 4 cases(5 %),oral antidiabetic drugs 3 cases(4 %),hypolipidemic agents 3 cases((4 %),) antiepileptics 2 cases(3 %),antipsychosis drug 1 case(1 %),antiviral drug 1 case(1 %),heroin 1 case(1 %),yellow fever vaccine 1 case((1 %)),without clinical manifestation 29 cases((37 %)),anepithymia or vomiting 38 cases(48 %),fever 24 cases(30 %),skin eruption or pruritus 10 cases(13 %),arthralgia 4 cases(5 %),jaundice 30 cases(38 %),hepatomegaly or splenomegaly 12 cases((15 %)),ascites 2 cases(2 %),kaolin stool 1 case((1 %)).Eosinophil increase 11 cases(14 %),with history of drug allergy 10 cases((13 %).) Forty-two cases were liver cell damaged type,8 cases were cholestasis type,29 cases were mixed type. CONCLUSION:The factor affect prognosis of drug induced liver disease is age,old disease and history of drug induced liver disease.The early diagnosis and timing therapy of drug induced liver disease should be highly valued.