132例药物性肝损伤临床分析

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。

Clinical analysis of 132 patients with drug-induced liver damage

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...