临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2014年
5期
438-441
,共4页
祁亚宾%邱玲%姜红丽%张睿%胡玉琳
祁亞賓%邱玲%薑紅麗%張睿%鬍玉琳
기아빈%구령%강홍려%장예%호옥림
肝炎,中毒性%中草药
肝炎,中毒性%中草藥
간염,중독성%중초약
hepatitis,toxic%drugs,Chinese herbal
目的：探讨药物性肝损伤的临床特点。方法回顾性分析2009年1月至2011年1月本院收治的394例药物性肝损伤患者的年龄、性别、肝损伤药物种类和名称、发病时间、肝功能、是否肝活组织检查、治疗情况及预后。结果药物性肝损伤病例呈逐年上升趋势。394例患者中男170例（43．15％），女224例（56．85％），男女发病比例为1∶1．3。高发年龄段为41～50岁（25.63％）及51～60岁（25．13％）。能引起药物性肝损伤的药物有很多种，居前3位的依次为：中药（45．43％）、多药联合应用（11.42％）及抗结核药（7．61％）。中药类别以治疗骨关节病中药（11％）和皮肤病中药（11％）为主，中药名称及成分多数不明。43例患者行病理检查确诊，占10．91％。较多见的病理改变为：中性粒细胞和嗜酸性粒细胞浸润（65．01％），毛细胆管性淤胆（39.93％）等，对临床诊断无特异性，有一定提示意义。394例患者中，治愈102例，占25．89％；好转184例，占46．70％。发生肝衰竭最终死亡的患者7例，占1.78％。总体预后较好，预后影响因素包括：年龄、临床分型、起病时TBil峰值等。结论致药物性肝损伤的药物种类繁多，临床表现缺乏特异性，诊断无金标准，故易漏诊及误诊，多数预后较好，但少数病例可发生肝衰竭。
目的：探討藥物性肝損傷的臨床特點。方法迴顧性分析2009年1月至2011年1月本院收治的394例藥物性肝損傷患者的年齡、性彆、肝損傷藥物種類和名稱、髮病時間、肝功能、是否肝活組織檢查、治療情況及預後。結果藥物性肝損傷病例呈逐年上升趨勢。394例患者中男170例（43．15％），女224例（56．85％），男女髮病比例為1∶1．3。高髮年齡段為41～50歲（25.63％）及51～60歲（25．13％）。能引起藥物性肝損傷的藥物有很多種，居前3位的依次為：中藥（45．43％）、多藥聯閤應用（11.42％）及抗結覈藥（7．61％）。中藥類彆以治療骨關節病中藥（11％）和皮膚病中藥（11％）為主，中藥名稱及成分多數不明。43例患者行病理檢查確診，佔10．91％。較多見的病理改變為：中性粒細胞和嗜痠性粒細胞浸潤（65．01％），毛細膽管性淤膽（39.93％）等，對臨床診斷無特異性，有一定提示意義。394例患者中，治愈102例，佔25．89％；好轉184例，佔46．70％。髮生肝衰竭最終死亡的患者7例，佔1.78％。總體預後較好，預後影響因素包括：年齡、臨床分型、起病時TBil峰值等。結論緻藥物性肝損傷的藥物種類繁多，臨床錶現缺乏特異性，診斷無金標準，故易漏診及誤診，多數預後較好，但少數病例可髮生肝衰竭。
목적：탐토약물성간손상적림상특점。방법회고성분석2009년1월지2011년1월본원수치적394례약물성간손상환자적년령、성별、간손상약물충류화명칭、발병시간、간공능、시부간활조직검사、치료정황급예후。결과약물성간손상병례정축년상승추세。394례환자중남170례（43．15％），녀224례（56．85％），남녀발병비례위1∶1．3。고발년령단위41～50세（25.63％）급51～60세（25．13％）。능인기약물성간손상적약물유흔다충，거전3위적의차위：중약（45．43％）、다약연합응용（11.42％）급항결핵약（7．61％）。중약유별이치료골관절병중약（11％）화피부병중약（11％）위주，중약명칭급성분다수불명。43례환자행병리검사학진，점10．91％。교다견적병리개변위：중성립세포화기산성립세포침윤（65．01％），모세담관성어담（39.93％）등，대림상진단무특이성，유일정제시의의。394례환자중，치유102례，점25．89％；호전184례，점46．70％。발생간쇠갈최종사망적환자7례，점1.78％。총체예후교호，예후영향인소포괄：년령、림상분형、기병시TBil봉치등。결론치약물성간손상적약물충류번다，림상표현결핍특이성，진단무금표준，고역루진급오진，다수예후교호，단소수병례가발생간쇠갈。
Objective To analyze the clinical characteristics of drug-induced liver injury (DILI).Methods A retrospective analysis was performed on the clinical data of 394 patients with DILI who were admitted to our hospital from 2009 to 2011.The studied factors included age,sex,names and categories of toxic drugs,time of onset,liver function,whether liver biopsy was performed,treatment,and prognosis. Results There is an upward trend in cases of DILI.Among the 394 patients with DILI,170 (43.15%)were males,and 224 (56.85%) were females;the male-to-female ratio was 1∶1.3;the peak ages were 41 -50 years (25.63%)and 51 -60 years (25.13%).A varie-ty of drugs could cause DILI,with traditional Chinese medicines (TCMs)(45 .43%)as the most common one,followed by a combination of drugs (11.42%)and antitubercular drugs (7.61%).The TCMcategory mainly included those for treating osteoarthrosis (11%)and der-matosis (11%),and the drug names and components were mostly unknown.Forty-three cases (10.91%)were confirmed by pathological examination,and the common pathological changes included infiltration of neutrophils and eosinophils (65.01%)and cholestasis of capillar-y bile ducts (39.93%),which had no specificity for clinical diagnosis,but provided some hint.Among the 394 patients,102 (25.89%) were cured,184 (46.70%)showed an improvement,and 7 (1.78%)progressed to liver failure and death.The overall prognosis was good;the prognostic factors included age,clinical classification,and peak level of total bilirubin.Conclusion A variety of drugs can cause DILI,which has no specific clinical manifestations and gold diagnostic criteria,often leading to misdiagnosis;most cases have good progno-sis,but liver failure may occur in some cases.
