药物性肝损伤的发病因素及临床研究-etiological factors and clinical study of drug-induced liver injury.docxVIP

药物性肝损伤的发病因素及临床分析摘要目的：讨论药物性肝损伤(DILI)的病因、临床特点。方法：回顾性分析山西医科大学第一医院 2009 年 5 月至 2014 年 4 月诊断为 DILI 的 215 例完整的临床病例，分析其用药种类、危险因素、临床症状、生化检查及预后 等因素作用。结果：（1）发病人数呈逐年递增趋势，引起 DILI 的药物中居前三位的是中草药、抗 生素和抗甲状腺药，发病与老年人、女性、过敏体质、饮酒史及基础肝脏病史等 因素有关。（2）临床症状主要是黄疸、纳差、乏力、恶心呕吐及腹胀等。在三种临床分 型中比较：黄疸发生率在胆汁淤积型组中最高（P=0.001）；恶心呕吐、腹胀、无 明显症状在肝细胞损伤型组中发生率最高（P 均0.05）；混合型组无明显特征。 实验室检查示 ALT 值在肝细胞损伤型组最高(P=0.001)。（3）DILI 患者死亡率 8.37%。重型肝炎组的 TBIL 值高于普通肝炎组（P=0.001）， 同时 TBIL 峰值是患者死亡的独立危险因素（P=0.001）。结论：DILI 起病隐匿，临床无特异性诊断标准，应谨慎使用可能导致肝损伤的药物， 注意监测肝功能。关键词：药物性肝损伤；危险因素；临床特征；预后IFactors and clinical analysis of Drug-induced liver injury Abstract0bjective：To evaluate the influences,clinical characteristics and prognosis of drug-induced liver injury.Methods:Complete clinical dates of 215 DILI patients from May 2009 to April 2014 in the First Hospital Of Shanxi Medical University were analyzed retrospectively. The drugs category, pathogeny, clinical characteristics, blood biochemistry examination and the prognostic factors were evaluated.Results:The incidence was increasing year by year. The 3 most common drugs inducing DILI were Chinese herbal medcine, antibiotics and anti-thyroid drug. The influences were primarily older, female, allergies, alcohol history, liver disease history and so on.The main clinical symptoms were jaundice, anorexia, fatigue, nausea, vomiting and distension etc. In the cholestatic type, the occurrence of jaundice (P=0.001). In the hepatcellular injury type, the occurrence of nausea, vomiting, bloating and no obvious symptoms were the highest (P0.05). There was no obvious characteristics in the mixed injury type. Laboratory tests showed that ALT of the hepatcellular injury type was the highest (P=0.001).Mortality of DILI 8.37%. The TBIL of severe hapatitis type was higher than the common type (P=0.001), and peak value of TBIL was independent prognostic factors for survival (P=0.001).IIConclusions:Some DILI patients had occult onsets and others had nonspecific symptom. Liver function should be monitored w