急性药物性肝损伤179例临床分析

目的探讨急性药物性肝损伤临床表现特点、分型、病因、治疗及分析预后，以指导临床诊断和治疗。方法采用急性药物性肝损伤诊断及分类国际共识标准，回顾性调查近5年来中山大学附属第一医院179例急性药物性肝损伤住院患者的临床资料。结果本研究中有48％的患者无明显临床症状体征，其余亦缺乏特异性；有肝细胞型137例（76．11％），胆汁淤积型24例（14．33％），混合型18例（10．56％）。符合重症肝损伤者6例；引起肝功能损伤的药物种类很多，本组最常见的为化疗药、抗结核药、中草药；85．55％患者预后较好，主要肝功能指标于30d内恢复至正常上限两倍以内。6例发展为重型肝损伤，预后较差。结论急性药物性肝损伤症状缺乏特异性，不能单纯根据症状确定诊断；本组患者急性药物性肝损伤的类型以肝细胞型为主；临床上可以引起急性药物性肝损伤的药物种类很多，但以化疗药、抗结核药、中草药发生率最高，临床应用此类药物时，应注意监测肝功能在本组患者中急性药物性肝损伤一般预后较好，但亦可发生严重肝损害，应及时采取措施处理。

Clinical analysis of 179 cases of acute drug-induced liver injury

Objective To investigate the clinical manifestation, designation, causative drugs, therapy and the prognosis of acute drug-induced liver injury to guide clinical diagnosis and therapy. Methods One hundred and seventy-nine inpatients with acute drug-induced liver injury in our hospital in the past five years（2000.1 -2004.12） were retrospectively investigated with the causality assessment method of acute drug-induced liver diseases based on international consensus meeting （international criteria）. Results No obvious symptoms and signs were shown in 48% cases. In this study, 137 （76.11% ）, 24（ 14.33% ）, 18 （10.56%）cases were designated hepatocellular, cholestetic and mixed accordingly while 6 cases were diagnosed as severe liver injury. Many drugs could cause liver injury. The most common drugs were antineoplastic drugs,antituberculosis drugs and Chinese traditional and herbal drugs. Most of the cases （85.55%）recovered in 30 days after withdrawal of the causative drug（s） and giving proper supportive therapy though 6 cases developed into severe liver injury and had unfavorable prognosis. Conclusion The symptoms of acute drug-induced liver injury are unspecific, which the diagnosis should not base on. In this study, the most common designation is hepatocellular. Many drugs can cause acute liver injury. Liver function monitoring is necessary when using these kinds of drugs. The prognosis is usually good in this study. But severe liver injury can also occurs, so steps should be taken to handle this.