| 摘要: |
| 目的 探讨药物性肝损伤（DILI）患者的临床特征，为其诊治提供参考。方法 回顾性分析海军军医大学（第二军医大学）第三附属医院2017年1月至2021年12月诊断为DILI的住院患者的临床资料，包括患者的基本信息、基础疾病、用药史、临床表现、实验室检查指标、DILI严重程度及预后等。结果 145例DILI患者中肝细胞损伤型112例（77.24%）、胆汁淤积型25例（17.24%）、混合型8例（5.52%）。引起DILI的药物种类主要为中药、中成药和抗感染药物，分别占48.72%（76/156）、16.03%（25/156）和10.26%（16/156）。DILI常见的临床表现为黄疸（76.55%）、纳差（52.41%）、乏力（49.66%）。不同肝损伤类型间，丙氨酸转氨酶（ALT）、天冬氨酸转氨酶、碱性磷酸酶、总胆红素（TBil）、γ-谷氨酰转移酶、白蛋白（ALB）水平及住院时间、DILI严重程度分布差异均有统计学意义（均P＜0.05）。经治疗后好转组ALT、ALB水平高于预后不良组，TBil水平及国际标准化比值（INR）低于预后不良组，差异均有统计学意义（均P＜0.05）；多因素分析结果显示，INR为DILI预后的独立预测因素（P＜0.05）。结论 血清生物化学指标有助于判别DILI的临床分型及预后。中药及中成药等多种药物可能会引起DILI，医务人员应予以重视并加强公众科普宣教。 |
| 关键词: 药物性肝损伤 临床分型 临床特征 预后 影响因素 |
| DOI：10.16781/j.CN31-2187/R.20230220 |
| 投稿时间：2023-04-20修订日期：2024-05-07 |
| 基金项目:医院医疗质量安全改进项目（2023-09）. |
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| Clinical characteristics and prognostic factors of 145 patients with drug-induced liver injury |
| DU Hongli,LI Xu,SHAN Xuechun,HU Yunying,BAO Leilei*,WANG Hui* |
(Department of Pharmacy, The Third Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200438, Chin
*Corresponding authors) |
| Abstract: |
| Objective To explore the clinical characteristics of patients with drug-induced liver injury (DILI), so as to provide references for its diagnosis and treatment. Methods The clinical data of inpatients diagnosed as DILI in The Third Affiliated Hospital of Naval Medical University (Second Military Medical University), from Jan. 2017 to Dec. 2021 were retrospectively analyzed, including basic information, underlying diseases, drug use history, clinical manifestations, laboratory indexes, severity and prognosis of DILI. Results Among 145 patients with DILI, 112 cases (77.24%) were hepatocellular type, 25 cases (17.24%) were cholestatic type, and 8 cases (5.52%) were mixed type. The types of drugs causing DILI mainly included traditional Chinese medicine, proprietary Chinese medicine and anti-infective drugs, and the proportions were 48.72% (76/156), 16.03% (25/156), and 10.26% (16/156), respectively. The common clinical manifestations of DILI patients were jaundice (76.55%), poor appetite (52.41%), and fatigue (49.66%). The levels of alanine transaminase (ALT), aspartate transaminase, alkaline phosphatase (ALP), total bilirubin (TBil), γ-glutamyl transferase and albumin (ALB), as well as the length of hospital stay and severity distribution were significantly different among different types of liver injury (all P＜0.05). The levels of ALT and ALB in the good prognosis group were significantly higher than those in the poor prognosis group, while the levels of TBil and international normalized ratio in the good prognosis group were significantly lower than those in the poor prognosis group (all P＜0.05). Multivariate analysis showed that INR was an independent predictor of the prognosis of DILI (P＜0.05). Conclusion Serum biochemistry indicators can help to identify the clinical classification and prognosis of DILI. Traditional Chinese medicine, proprietary Chinese medicine and other drugs can cause DILI. Medical staff should pay attention to it and strengthen public health education. |
| Key words: drug-induced liver injury clinical types clinical characteristics prognosis influencing factors |
