61例药物性肝衰竭临床资料分析

目的:分析61例药物性肝衰竭的临床特征及其预后,以提高对药物性肝衰竭的认识。方法:采用回顾性研究对61例药物性肝衰竭住院患者的用药史、临床表现、实验室检查、并发症及预后相关因素进行综合分析。结果:61例患者中,引起肝衰竭的前3名的药物主要是中药(16例,26.2%)和抗结核药(13例,21.3%),抗肿瘤药(6例,9.8%);肝衰竭类型以急性(28例,45.9%)、亚急性(25例,41%)为主;并发症发生率最高的是腹水、肝性脑病和腹腔感染,而病死率最高的前2位并发症分别为腹水、肝肾综合征,腹腔感染和消化道出血并列第3位;总治愈好转率为26.2%;实验室指标分析表明,凝血酶原活动度(PTA)、丙氨酸氨基转移酶(ALT)、天门冬酸氨基转移酶(AST)、谷氨酰转肽酶γ-GGT、总胆红素(TBIL)、白蛋白(ALB)、碱性磷酸酶(ALP)、胆碱酯酶(CHE)在好转组与无效组之间差异无统计学意义(P>0.05)。结论:药物性肝衰竭的致病药物主要是中药和抗结核药,其治愈好转率低下,预后不良,用药过程中应予以严密监测。

AnaIysis of Clinical Data of 61 Cases of Drug-induced Liver Failure

Objective:To analyze the clinical features and prognosis of 61 patients with drug-induced liver failure.Methods:61 patients of drug-induced liver failure admitted to our hospital from 2002~2007 were reviewed according to their drug history,clinical features,Laboratory tests,complications and prognosis.Results:Among the 61 inpatients,16 cases were caused by the traditional Chinese medicine(26.2%),13 were caused by antitubercular agent(21.3%) and 6 cases were caused by the antineoplastic drug(9.8%).Two predominant types of liver failure were acute liver failure(45.9%)and subacute hver failure(41%).The commonest complications were ascites,hepatic encephalon and enterocol.ic infection.The commonest complications associated with high mortality were ascites,hepatorenal syndrome.The total improvement rate in patients Was 26.2%.The laboratory data indicated that PTA,ALT,AST,γ-GGT,TBIL,ALB,ALP and CHE had no statistical difference between improvement group and ineffective group(P>0.05).Conclusion:The predomiant drugs induced liver failure are traditional Chinese medicine,antituberculotic and antineoplastic drug in China.The prognosis of drug-induced liver failure remains poor.During the treatment,1iver function test should be monitored.