基于RUCAM量表的205例药物性肝损伤患者临床特点分析

目的 探讨药物性肝损伤(DILI)的病因构成、临床特点及预后因素。方法 根据Roussel Uclaf因果关系评估(RUCAM)量表纳入2012年1月至2015年3月住院治疗的205例患者,回顾性分析其临床资料。结果 引起DILI的前三位药物为:中药92例(44.87%)、抗结核药41例(20.00%)、抗菌药物14例(6.82%)。患者临床表现无特异性,以肝细胞损伤型DILI最常见,共126例(61.46%),胆汁淤积型67例(32.68%),混合型12例((5.85%)。205例患者中,190例达到治愈或好转,有效率为92.68%,其中肝衰竭型预后最差。结论 本组患者因中药引起的DILI所占比例最高,其次为抗结核药及抗菌药物,绝大部分DILI患者临床预后较好。

Clinical features of 205 cases of drug-induced liver injury with RUCAM scale-based diagnosis

Objective To analyze the etiology, clinical features and prognosis of liver injuries caused by different drugs.Methods According to the Roussel Uclaf Causality Assessment Method(RUCAM) scale, clinical outcomes and other associated data were retrospectively assessed for 205 patients with drug-induced liver injury(DILI) in the Department of Infectious Diseases from January 2012 to March 2015.Results The most prevalent agents inducing DILl were Chinese traditional drugs(44.87%), followed by anti-tuberculosis drugs(20.00%) and antibiotics(6.82%). In general, the clinical manifestations and biochemical results were not specific. The percentages of hepatocellular injury type, cholestatic injury type and mixed injury type were 61.46%, 32.68% and 5.85%, respectively. 190 patients were cured or improved, and the effective rate was 92.68%. The prognosis of the liver failure type was the worst.Conclusion Although anti-tuberculosis drugs(20.00%) and antibiotics are considered as common drugs that can induce DILI, Chinese traditional drugs have emerged as another important group of liver injuries agents. The majority of patients with DILI have good prognosis.