CAJ | 학술논문

目的探讨药物性肝损伤(DILI)的病因构成及临床和预后特点. 方法回顾性分析解放军第八一医院全军肝病中心2012年7月至2013年7月诊断为DILI的140例患者的临床资料,采用RUCAM量表评价药物应用史与肝损伤的相关性,并分析药物种类构成、DILI的临床类型及预后特点.结果引起本组患者DILI的前3位药物为中药87例(62.1％)、解热镇痛药14例(10％)、抗生素7例(5％).男女性别比为1∶1.69.＞40 ～＜60岁患者71例(50.7％).患者RUCAM分值均≥3,临床表现无明显特异性,肝细胞损伤型DILI最多见,共72例(51.4％),胆汁淤积型43例(30.7％),混合型25例(17.9％);胆汁淤积型DILI患者的中位年龄(55.6岁)较肝细胞型(47.1岁)及混合型DILI (49.9岁)高.药物性急性肝衰竭患者占7.86％.结论本研究患者中因中药引起的DILI所占比例最高,应引起高度重视;其次为解热镇痛药物和抗生素类药物.DILI的临床表现缺乏特异性,但老年患者相对易出现胆汁淤积.绝大多数DILI患者预后良好.
목적 탐토약물성간손상(DILI)적병인구성급림상화예후특점. 방법 회고성분석해방군제팔일의원전군간병중심2012년7월지2013년7월진단위DILI적140례환자적림상자료,채용RUCAM량표평개약물응용사여간손상적상관성,병분석약물충류구성、DILI적림상류형급예후특점.결과 인기본조환자DILI적전3위약물위중약87례(62.1％)、해열진통약14례(10％)、항생소7례(5％).남녀성별비위1∶1.69.＞40 ～＜60세환자71례(50.7％).환자RUCAM분치균≥3,림상표현무명현특이성,간세포손상형DILI최다견,공72례(51.4％),담즙어적형43례(30.7％),혼합형25례(17.9％);담즙어적형DILI환자적중위년령(55.6세)교간세포형(47.1세)급혼합형DILI (49.9세)고.약물성급성간쇠갈환자점7.86％.결론 본연구환자중인중약인기적DILI소점비례최고,응인기고도중시;기차위해열진통약물화항생소류약물.DILI적림상표현결핍특이성,단노년환자상대역출현담즙어적.절대다수DILI환자예후량호.
Objective To analyze the etiology,clinical features and prognosis of liver injuries caused by different drugs.Methods The types of suspected drugs related to liver injury,clinical manifestations,liver biochemical parameters,clinical outcomes and other associated data were retrospectively assessed for 140 patients with drug-induced liver injury (DILI).The Roussel Uclaf Causality Assessment Method (RUCAM) was used to assess the causality between drugs and liver injury.Results The most prevalent agents inducing DILI were Chinese traditional drugs (62.1％),followed by antipyretic analgesic drugs (10％) and antibiotics (5％).The ratio of male to female patients in the study cohort was 1∶1.69,with 71 of the total patients (50.7％) being between the ages of 40 and 60 years-old.The RUCAM scale was not less than 3 points for any of the patients.In general,the clinical manifestations and biochemical results were not specific.The percentages of hepatocellular injury type,cholestatic injury type and mixed injury type were 51.4％,30.7％ and 17.9％ respectively.The median age of patients with cholestatic liver injury was 55.6 years,which was older than that of patients with hepatocellular injury (47.1 years) or mixed injury (49.9 years).Conclusion Although antipyretic analgesics and antibiotics are considered as common drugs that can induce DILI,Chinese traditional drugs have emerged as another important group of liver injurious agents.Cholestatic DILI was found to occur more often in elderly patients than in younger patients.