药物性肝损伤的发病因素及临床分析

发布时间：2018-02-27 15:23

本文关键词： 药物型肝损伤危险因素临床特征预后　出处：《中华消化病与影像杂志(电子版)》2015年02期 　论文类型：期刊论文

【摘要】：目的探讨药物性肝损伤(DILI)的发病因素、临床特点及预后。方法回顾性分析山西医科大学第一医院2009年5月至2014年5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、生化检查及转归等。结果 (1)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。发病因素与老龄、女性、过敏体质、饮酒史及基础肝脏病病史等有关。(2)DILI患者的临床症状主要是黄疸、纳差、乏力、恶心呕吐及腹胀等。在胆汁淤积型组中,饮酒人数比例最高(P=0.019),黄疸发生率最高(P=0.001);在肝细胞损伤型组中,恶心呕吐、腹胀、无明显症状发生率最高(P均0.05);混合型组无明显特征。实验室检查示肝细胞损伤型组ALt值最高(P=0.000)。(3)DILI患者的病死率为8.37%。重型肝炎组的TBIL值高于普通肝炎组(P=0.000),同时TBIL峰值是患者死亡的独立危险因素(P=0.000)。结论 DILI的起病隐匿,临床无特异诊断标准,应谨慎使用可能导致肝损伤的药物,并注意监测肝功能。
[Abstract]:Objective to investigate the pathogenesis, clinical characteristics and prognosis of drug-induced liver injury (Dili). Methods 215 cases of DILI diagnosed from May 2009 to May 2014 in the first Hospital of Shanxi Medical University were analyzed retrospectively. Risk factors, clinical symptoms, biochemical examination and prognosis. Results the top three drugs causing DILI were Chinese herbal medicine, antibiotics and antithyroid drugs. The clinical symptoms of DILI patients were jaundice, anorexia, fatigue, nausea and vomiting, abdominal distention, etc. In the cholestasis group, the clinical symptoms of the patients were mainly jaundice, anorexia, nausea, vomiting and abdominal distention. The incidence of jaundice was the highest, and the incidence of jaundice was the highest. In the hepatocyte injury group, nausea and vomiting, abdominal distension, nausea and vomiting were observed. The highest incidences of asymptomatic symptoms were 0. 05%, while the mixed group had no obvious characteristics. Laboratory examination showed that the ALt value of hepatocyte injury type group was the highest. The mortality rate of patients with DILI was 8. 37. The TBIL value of severe hepatitis group was higher than that of normal hepatitis group (P 0. 000), and the peak value of TBIL was also found. It is an independent risk factor of death. Conclusion the onset of DILI is hidden. There are no specific diagnostic criteria in clinical use of drugs that may lead to liver injury and careful monitoring of liver function.
【作者单位】：山西医科大学第一医院感染病科;山西医科大学第一临床医学院;
【基金】：山西省科研攻关项目(201103113012-4) 山西省基础平台项目(2012091007)
【分类号】：R575

【参考文献】