170例药物性肝损伤患者临床特征分析

摘要/Abstract

摘要： 目的分析药物性肝损伤(DILI)患者的临床特征。方法回顾性分析2015年7月至2020年7月泰州市人民医院收治的170例DILI患者的临床资料,采用多元logistic回归、Kruskal-Wallis H检验、ROC-AUC等方法对数据进行分析。结果 170例患者的年龄为(46.7±13.5)岁,女性125例。患者服用中草药(何首乌、雷公藤、土三七、三七、鱼腥草、蒲公英、黑骨藤、癞宝草等)和膳食补充剂(减肥代餐剂、酵素、维生素复合剂、减肥剂)102例(60.0%)、服用抗菌药物28例(16.5%)、服用非甾体抗炎药14例(8.2%)。肝细胞损伤型118例(69.41%),胆汁淤积型29例(17.06%),混合型23例(13.53%)。18例患者行肝穿刺检查,病理基本符合DILI诊断,但是临床分型和病理分型的一致性并不理想(K值=0.04)。年龄≥40岁(P=0.025;OR=2.731;95%CI:1.134~6.576)、饮酒(P=0.003;OR=5.348;95%CI:1.786~16.234)和糖尿病(P=0.01;OR=8.848;95%CI:1.699~46.073)是DILI发生的独立危险因素。2例服用土三七胶囊超过1个月的患者死亡。结论 DILI患者发病年龄多在41~60岁,女性居多,中草药和膳食补充剂是DILI的主要致病因素,肝细胞损伤型是DILI的主要临床分型。肝活检有助于诊断,但并非DILI的必要诊断方法。大部分患者预后良好。

关键词: 药物性肝损伤, 临床特征, 临床分型, 中草药

Abstract: Objective To analyze the clinical characteristics of patients with drug-induced liver injury (DILI).Methods The clinical data of 170 DILI patients admitted to Taizhou People's Hospital from July 2015 to July 2020 were retrospectively analyzed. Multivariate logistic regression, Kruskal-Wallis H test and ROC-AUC were used to analyze the data.Results The age of 170 patients was (46.69±13.53) years old, of which 125 were female (73.5%). The top three suspicious drugs: 102 cases (60.0%) of Chinese herbal medicines (Polygonum multiflorum, Tripterygium wilfordii, Sedum tatarinowii, Panax notoginseng, Houttuynia cordata, Dandelion, Black bone vine, Leprosy grass, etc.) and dietary supplements (weight loss meal replacement agents, enzymes, vitamin complexes, weight loss agent), 28 cases (16.5%) of antibacterial drugs, and 14 cases (8.2%) of non-steroidal anti-inflammatory drugs. There were 118 cases (69.41%) of hepatocellular type, 29 cases (17.06%) of cholestatic type, and 23 cases (13.53%) of mixed injury type. A total of 18 patients underwent liver biopsy, and pathology basically were consistent with DILI diagnosis, but the consistency between the clinical types and pathological types was not ideal (K value=0.04<0.4). Age≥40 years old (P=0.025; OR=2.731; 95%CI: 1.134, 6.576), drinking (P=0.003; OR=5.348; 95%CI: 1.786, 16.234) and diabetes (P=0.01; OR=8.848; 95%CI: 1.699, 46.073) are independent risk factors for DILI. Two patients who took Sedum tatarinowii capsules for more than 1 month died.Conclusion DILI patients are mostly 41-60 years old and women. Chinese herbal medicine and dietary supplements are the main pathogenic factors of DILI. Hepatocellular type is the main clinical type of DILI. Liver biopsy is helpful for diagnosis, but it is not a necessary diagnostic method for DILI. Most patients have a good prognosis.

Key words: Drug-induced liver injury, Clinical features, Clinical types, Chinese herbal

赵娇, 肖丽. 170例药物性肝损伤患者临床特征分析[J]. 肝脏, 2022, 27(6): 683-687.

ZHAO Jiao, XIAO Li. Analysis of clinical characteristics of 170 patients with drug-induced liver injury[J]. Chinese Hepatolgy, 2022, 27(6): 683-687.

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