住院患者药物性肝损伤病因分析及熊去氧胆酸协同治疗疗效观察

目的 观察熊去氧胆酸协同治疗药物性肝损伤（DILI）患者的临床疗效,分析我院引起DILI的药物种类及其发生比例。方法 纳入我院200例药物性肝损伤患者,分析引起DILI的药物种类。将患者分成两组,对照组给予异甘草酸镁、谷胱甘肽和多烯磷酯酰胆碱中的1~3种药物治疗,对伴有高胆红素血症者加用腺苷蛋氨酸;治疗组在对照组治疗的基础上,加用熊去氧胆酸,两组疗程均为4 w,观察治疗后肝功能变化和临床疗效。结果 本组引起DILI的首位药物是免疫抑制剂（34.0%）,其次为中药（28.5%）,其后依次为抗生素（13.0%）、抗结核药物（7.5%）、抗肿瘤化疗药（7.5%）和解热镇痛药（4.5%）;治疗组在肝功能改善方面明显优于对照组（P<0.01）,尽管两组患者肝功能均有明显改善。结论 引起我院住院患者DILI的最常见的药物为免疫抑制剂,可能与我院开展器官移植较多有关。熊去氧胆酸在甘草酸制剂等的基础上可以较快地改善DILI患者肝功能。

Common agents in patients with drug-induced liver injury and observation of therapeutic efficacy of ursodeoxycholic acid

Objective To investigate the common agents related to drug-induced liver injury（DILI） in our hospitalized patients and to observe the clinical efficacy of ursodeoxycholic acid in treatment of patients with DILI. Methods Two hundred patients with DILI were recruited in this study and the common agents were analyzed. The patients were divided into two groups. Patients in control group received magnesium isoglycyrrhizinate, glutathione and polyene phosphatidylcholine（one,two,and all or any combination of them） for four weeks. Ademetionine was given when hyperbilirubinemia appeared. The patients in observation group received additionally ursodeoxycholic acid for four weeks at the base treatment in the control. Results The leading agents in our patients with DILI were immunosuppressive agents（34.0%）,followed by traditional Chinese medicin（28.5%）,and other common agents were antibacterial（13.0%）,antitubercular agents（7.5%）, chemotherapeutics（7.5%）,and antipyretic analgesics（4.5%）. Liver function improved in both groups after four week treatment,while the efficacy was superior in ursodeoxycholic acid-treated patients（P<0.01）. Conclusion Immunosuppressive agents are the main causes of DILI in our hospitalized patients, and the ursodeoxycholic acid could improve the efficacy of basic treatment such as glycyrrhizin in patients with DILI.