CAJ | 학술논문

目的：分析该院近年来导致药物性肝损伤的常见药物种类、药物性肝损伤的临床特点、诊断及预后，提高临床医生对本病的认识，指导临床合理用药。方法根据Danan标准RUCAM简化评分系统对2002年4月-2012年4月间临床诊断为药物性肝损伤而入住该院的198例病例进行回顾性分析，采用SPSS 17．0软件将数据进行χ2检验，P＜0．05为差异有统计学意义。结果198例患者中，引起肝损伤的药物主要为中草药、抗结核药、抗肿瘤药、抗生素等，共占62．12％，男性97例（48．99％），女性101例（51．01％）；年龄3～88岁，中位年龄47岁；第一次服药至发生肝损伤的潜伏期在4～180 d，中位时间26 d；肝细胞损伤型124例（62．63％），胆汁淤积型35例（17．68％），混合型39例（19．69％）；38例无明显临床症状或体征，仅有实验室检查异常（19．19％），而有临床症状160例（80．81％），主要表现为乏力（65．66％）、纳差（52．02％）、眼黄尿黄（44．95％）；经治疗后痊愈59例（29．80％），好转108例（54．55％），自动出院28例（14．14％），死亡3例（1．52％），预后较好。结论该院198例药物性肝损伤主要临床类型为肝细胞损伤型，临床特点与各类型急、慢性肝脏疾病相似，并无特异性，预后好。
목적：분석해원근년래도치약물성간손상적상견약물충류、약물성간손상적림상특점、진단급예후，제고림상의생대본병적인식，지도림상합리용약。방법근거Danan표준RUCAM간화평분계통대2002년4월-2012년4월간림상진단위약물성간손상이입주해원적198례병례진행회고성분석，채용SPSS 17．0연건장수거진행χ2검험，P＜0．05위차이유통계학의의。결과198례환자중，인기간손상적약물주요위중초약、항결핵약、항종류약、항생소등，공점62．12％，남성97례（48．99％），녀성101례（51．01％）；년령3～88세，중위년령47세；제일차복약지발생간손상적잠복기재4～180 d，중위시간26 d；간세포손상형124례（62．63％），담즙어적형35례（17．68％），혼합형39례（19．69％）；38례무명현림상증상혹체정，부유실험실검사이상（19．19％），이유림상증상160례（80．81％），주요표현위핍력（65．66％）、납차（52．02％）、안황뇨황（44．95％）；경치료후전유59례（29．80％），호전108례（54．55％），자동출원28례（14．14％），사망3례（1．52％），예후교호。결론해원198례약물성간손상주요림상류형위간세포손상형，림상특점여각류형급、만성간장질병상사，병무특이성，예후호。
Objective To analyze pathogenesis,clinical features,diagnosis and prognosis of drug-induced liver injure in recent years in order to improve clinical doctors’awareness of this problem.Methods We scored 198 patients with drug-induced liver injure admitted to Yixian Hospital from April 2002 to April 2012 according to Danan diagnostic criteria (RUCAMsimplified scoring system).These ca-ses were analyzed retrospectively and with SPSS 17.0 software byχ2-test.There existed statistical heterogeneity when P<0.05.Results Of the 198 cases,the major drugs that caused DILI were Chinese medicinal herbs,antitubercular drug,antineoplastic drug and antibi-otics,which accounted for 62.12% of all.There were 97 male cases (48.99%)and 101 female cases (51.01%).The youngest pa-tient was 3 years old while the oldest was 88 years old,median age being 47.The period between the time of taking medicine and the time of occurrence of DILI was 4 days to 180 days,median time to the progression being 26d.Of all the cases there were 124 hepatocel-lular injury (62.63%),35 cholestasis (17.68%),and 39 mixed type (19.69%).There were 38 patients (19.19%)with no clinical symptom or objective sign but abnormal lab findings,while the other 160 patients (80.81%)had clinical symptoms including fatigue (65.66%),anorexia(54.55%),and colored sclera or urine(44.95%).After appropriate treatment,59 patients (29.80%)were cured,108 patients (54.55%)were improved,28 patients (14.14%)left hospital without cure,and 3 patients (1.52%)died.Con-clusions The main damage type in the 198 cases of DILI is hepatic cellular injury,clinical feature of which is similar to each acute or chronic liver disease.It has no specificity,and the prognosis is good.