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95例药物性肝损伤的临床特点与预后
Clinical features and prognosis of drug-induced liver injury: An analysis of 95 cases
文章发布日期:2018年05月07日  来源:  作者:闫蓉,宋政  点击次数:144次  下载次数:15次

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【摘要】:目的对现有的药物性肝损伤(DILI)临床资料进行分析总结,以了解其临床特点及预后。方法采用回顾性调查方法,收集2010年2月-2016年2月西安医学院第一附属医院收治的95例DILI患者临床资料,分析患者性别、年龄、用药史、基础疾病、临床表现、实验室及影像学检查、治疗情况及转归等。采用logistic回归分析影响预后的危险因素。结果引起DILI的药物所治疗的基础疾病中,呼吸系统疾病占首位,占25.26%(24/95),其中结核占23.16%(22/95)。导致DILI的药物中,最常见的为中药类,占44.21%(42/95),其次为抗结核药物,占22.11%(21/95)。从服药至产生肝损伤的时间以15~30 d最常见。DILI的症状中以纳差最为常见,最常出现的阳性体征是黄疸。DILI的实验室肝功能检查以ALT升高最为明显。最常见的DILI类型是急性肝细胞损伤型。DILI患者大多数预后良好,经停药及治疗后,治疗有效者(包括治愈和好转)占95.79%(91/95)。年龄[比值比(OR)=0054,95%可信区间(95%CI):0.002~0.076,P=0.037]、ALP(OR=0.004,95%CI:0.001~0.006,P=0.043)、TBil(OR=0.028,95%CI:0.001~0.039,P=0.035)、DBil(OR=0.008,95%CI:0.001~0.014,P=0.036)可能是影响预后的独立相关危险因素。结论DILI临床表现无特异性,易漏诊及误诊,临床医师要合理用药,监测药物可能出现的肝毒性反应,还需加强安全用药的公众健康教育。
【Abstract】:ObjectiveTo analyze and summarize the clinical data of drug-induced liver injury (DILI), and to investigate the clinical features and prognosis of DILI. MethodsA retrospective analysis was performed for the clinical data of 95 patients with DILI who were admitted to The First Affiliated Hospital of Xi′an Medical University from February 2010 to February 2016, including sex, age, medication history, underlying diseases, clinical manifestation, laboratory and imaging findings, treatment, and prognosis. A logistic regression analysis was used to investigate the influencing factors for prognosis. ResultsRespiratory system diseases ranked first among the underlying diseases treated by drugs that caused DILI and accounted for 25.26% (24/95), and of all patients, 23.16% (22/95) had tuberculosis. Among the drugs that caused DILI, traditional Chinese medicine ranked first and accounted for 44.21% (42/95), followed by antitubercular agents which accounted for 22.11% (21/95). DILI often occurred within 15-30 days of medication. Poor appetite was the most common symptom of DILI, and jaundice was the most common positive sign. Elevated alanine aminotransferase was the most common laboratory result of DILI. Acute hepatocellular injury type was the most common type of DILI. Most DILI patients had good prognosis, and patients with response to treatment accounted for 95.79% (91/95), including those who were improved or cured. Age (odds ratio [OR]=0.054, 95% confidence interval (CI): 0.002-0.076, P=0.037), alkaline phosphatase (OR=0.004, 95% CI: 0.001-0.006, P=0.043), total bilirubin (OR=0.028, 95% CI: 0.001-0.039, P=0.035), and direct bilirubin (OR=0.008, 95% CI: 0.001-0.014, P=0.036) were independent risk factors for prognosis. ConclusionDILI does not have specific clinical manifestations and can easily be missed or misdiagnosed. Clinicians should use drugs rationally, monitor the presence of hepatotoxicity, and strengthen the public health education on safe medication.
【关键字】:药物性肝损伤; 疾病特征; 预后
【Key words】:drug-induced liver injury; disease attributes; prognosis
【引证本文】:
YAN R, SONG ZJ. Clinical features and prognosis of drug-induced liver injury: An analysis of 95 cases[J]. J Clin Hepatol, 2018, 34(6): 1242-1247. (in Chinese) 闫蓉, 宋政军. 95例药物性肝损伤的临床特点与预后[J]. 临床肝胆病杂志, 2018, 34(6): 1242-1247.

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