113例药物性肝损害临床特征及影响因素分析

目的分析病理诊断为药物性肝损害患者的临床特征及相关影响因素,比较CIOMS/RUCAM和Maria两种评分系统在诊断中的价值。方法选择上海瑞金医院感染科2008年7月～2010年11月经皮肝活组织检查病理诊断为药物性肝损害患者113例,分析年龄、性别、BMI、血清学指标、肝脏组织学改变、患病因素、临床表现及预后,并进行量化评分。结果 113例患者中女性77例,男性36例,平均年龄（47.73±13.17）岁。中药及减肥茶是引起药物性肝损害的主要因素,占48.67%;其余依次为抗微生物药、解热镇痛抗炎药和心血管类药。主要症状为乏力、恶心和上腹不适。临床分型以肝细胞损伤型为主,占47.79%,且女性为主;其余为胆汁淤积型及混合型。停用肝损害药物及对症治疗后,44.25%的患者1个月内肝功能恢复正常。合并自身免疫性肝炎（AIH）患者的纤维化分期评分（F）较高（P=0.015）。炎症活动指数（HAI）≥9且F≥4的患者占6.19%,其中42.86%肝功能异常持续半年以上或死亡。CIOMS/RUCAM评分≥6分占77.88%,Maria评分≥10分占60.18%。结论中药和减肥药是引起药物性肝损害的主要药物,停用相关药物后预后良好;肝细胞型中,女性发生率高于男性;合并症AIH影响肝脏的纤维化水平;HAI≥9且F≥4的患者预后较差;CIOMS/RUCAM评分系统敏感性高于Maria评分。

The analysis of clinical features and risk factors in 113 patients with drug - induced liver injury

Objectives To analyze the clinical manifestation and influencing factors of drug-induced liver injury（DILI）,and to compare the accuracy of two diagnostic criteria CIOMS/RUCAM and Maria score.Methods Retrospective analysis was performed on 113 patients who have been diagnosed as drug-induced liver injury by liver biopsy in Ruijin hospital between July 2008 and November 2010.Age,sex,BMI,serological indicators,liver biopsy histologic changes,causes,clinical manifestation and prognoses were recorded.Results Among the 113 patients,77 patients were female and 36 patients were male.The average age was 47.73±13.17.Chinese herbal medicine and diet tea were the main causes of DILI（48.67%）,followed by antibiotics,antipyretic analgesic anti-inflammatory drugs and cardiovascular drugs.The main symptoms were asthenia,nausea and epigastric discomfort.Classification： 47.79% of the patients were the injury type of hepatocytes,and most of them were female.The rest were the type of cholestasis and mix type.44.25% of the patients reached to normal liver function after 1 month treatment.Ishak fibrosis score（F） of the patients with the complication-AIH was high（P=0.015）.There were 7 cases（6.19%） falling into both histological activity index（HAI）≥9 and F≥4,and 42.86% of them kept the liver function abnormal over half a year or died.CIOMS/RUCAM score≥6 and Maria score≥10 were 77.88% and 60.18%,respectively.Conclusion Chinese herbal medicine and diet tea were the main causes of DILI.Most of patients reinstated well after abandoning the medicine.Most of the hepatocytes type were female.The complication-AIH would influence over Ishak fibrosis score.Patients with HAI≥9 and F≥4 had poor prognosis.The sensitivity of RUCAM score was higher than Maria score.