急性药物性肝损伤230例临床分析

目的 对急性药物性肝损伤患者进行临床分析,以提高对该病的认识.方法 对2005年10月至201 1年5月期间在我院住院的230例急性药物性肝损伤患者的临床资料进行回顾性分析.结果 230例患者中60％以上有乏力、纳差及黄疸,肝功能损伤以ALT、AST、碱性磷酸酶（ALP）及总胆红素变化为主.有肝细胞损伤型185例（80.4％）,胆汁淤积型27例（11.7％）,混合型18例（7.8％）.引起药物性肝损伤的药物种类很多,最多见的为中草药汤剂及中成药（55.2％）、抗结核药（9.6％）和其他抗细菌药（5.2％）.218例（94.7％）患者预后良好,预后不良12例（5.3％）,包括加重后自动出院4例,死亡8例.结论 药物性肝损伤的诊断缺乏“金标准”,易误诊漏诊.引起药物性肝损伤的药物种类很多,应注意中草药、抗结核药、其他抗微生物药等.急性药物性肝损伤多数预后良好,但亦可发生严重肝损害,应尽早发现及时处理.

Clinical analysis of 230 cases of drug-induced liver injury

Objective To review the clinical features of acute drug-induced liver injury.Methods The clinical data of 230 patients with acute drug-induced liver injury admitted to Beijing Ditan Hospital from October 2005 to May 2011 were retrospectively analyzed.Results In 230 patients,more than 60％ had symptoms of fatigue,anorexia,jaundice and liver damage presenting LT,AST,ALP and TBIL changes.The hepatocellular injury type accounted for 80.4％ （185/230）,cholestatic type accounted 11.7％ （27/230） and mixed type accounted for 7.8％ （18/230）.Chinese herbal medicine or Chinese patent medicine was the most common cause of drug-induced liver injury （55.2％）,followed by anti-TB drugs （9.6％） and other anti-bacterial drugs （5.2％）.There were 218 cases （94.7％） with favorable prognosis and 12 cases （5.3％） with poor prognosis,including 4 aggravating cases discharged against medical advance and 8 deaths.Conclusion The lack of ＂gold standard＂ for the diagnosis of drug-induced liver injury may easily lead to misdiagnosis.Chinese Traditional medicine,anti-TB drugs and other anti-microbial drugs are main causes of drug-induced liver injury.Early detection and timely treatment are important for the management of drug-induced liver injury.