AIDS／HIV药物性肝损伤的临床分析

目的探讨艾滋病（AIDS）／HIV感染者药物性肝损伤（DILD）的影响因素．方法对2005年1月至2008年10月在我院住院的84例诊断为AIDS／HIV药物性肝损伤的患者进行回顾性分析．结果84例患者中，抗病毒药物引起的肝损伤患者占34．52％（29／84）；抗真菌类药物占13．09％（11／84）；抗结核药物占17．85％（15／84）；32例原有HCV／HBV（丙型肝炎／乙型肝炎）病史，但肝功能正常、HBVDNA、HCVRNA均在检测值以下，联用抗病毒类药物后引起肝损伤者占21．42％（18／84）；抗生素、中药、解热镇痛药各占3．56％；其他占2．38％．艾滋病／HIV感染者合并真菌感染21例，合并结核感染17例，合并HCV／HBV感染32例．联合用药组较单纯抗病毒治疗组DILD的发生率高（P〈0．05）．84例药物性肝损伤患者的临床分型：肝细胞损伤型45．24％（38／84），胆汁淤积型22．62％（19／84），混合型32．14％（27／84）．结论AIDS／HIV感染者时易发生肝损伤，抗真菌感染、抗结核或有肝病者联合用药DILD抗病毒药物治疗的发生率较高；药物性肝损伤的肝细胞损伤型最为常见，应引起临床医生重视．

Clinical Analysis of Drug Induced Liver Disease in AIDS/HIVPatients

Objective To analyze clinical influencing factors of drug induced liver disease （DILD） in AIDS/HIV patients. Method Eighty-four in-hospital AIDS/HIV cases with DILD during January 2005 and October 2008 were retrospectively analyzed. Results Among the 84 cases, 34.52% （29/84） liver injuries were induced from HAART medicine, 13.09% （11/84） by antifungal medicine, 17.85% （15/84） from anti-tuberculosis medicine, 21.42% （18/84） from HAART medicine in HBV/HCV cases who had normal liver functions and undetectable HBVDNA, HCVRNA levels before the treatment, 33.56% （3/84） from antibiotics, 3.56% （3/84） from herbal medicines and antipyretie analgesics and 2.38% （2/84） by unknown reasons. Among the total, 21 cases co-infected with fungus, 17 cases with TB and 32 with HBV/HCV. Hncidenee of DILD in combination medication group was higher than pure HAART group （P 〈 0.05）. Clinical type for DILD of the 84 cases：Thirty-two percent （27/84） was of hepatocellular injury, 22.62% （19/84） of hepatic cholestasis and 45.24% （38/84） of the mixture （hepatocellular injury with hepatic cholestasis） type. Conclusion High incidence of DILD is verified among AIDS/HIV patients co-infected with fungal, lung TB, hepatitis; High incidence of DILD is induced by HAART medicines, antifungal medicines and anti-TB medicines. The most common type of liver injury is hepatocellular injury and should arouse clinicians attention.