122例急、慢性药物性肝损伤患者临床观察

摘要/Abstract

摘要： 目的分析急、慢性DILI的临床特点及转归。方法 2015年1月—2021年12月扬州大学附属苏北人民医院收治的122例DILI患者纳入研究,其中男79例、女43例,年龄50(38, 68)岁;依据病程分为急性DILI(n=101)、慢性DILI(n=21)。DILI诊断符合诊断要求。比较急、慢性DILI患者病因、临床特点及临床转归情况。结果急、慢性DILI病因药物种类相似,主要病因包括中成药(78例,63.9%)、抗菌类药物(15例,12.3%)及镇痛解热药(13例,10.6%)。急性DILI患者PLT、ALT及AST为212(104, 376)×10⁹/L、276(29, 711)U/L及168(18, 643)U/L,与慢性DILI[162(84, 235)×10⁹/L、80(12, 318)U/L及114(10, 307)U/L]比,差异具有统计学意义(P<0.05);急性DILI患者ANA(+)、SMA(+)分别为38例(37.6%)、4例(4.0%),明显低于慢性DILI[13例(61.9%)、4例(19.0%),P<0.05]。分析急、慢性DILI患者临床转归情况,急性DILI患者潜伏期[32(2, 150)d]显著短于慢性DILI[44(12, 260)d,P<0.05];急性DILI患者激素治疗、激素+免疫抑制剂治疗分别为9例(8.9%)、1例(1.0%),与慢性DILI[8例(38.1%)、5例(23.8%)]相比,差异具有统计学意义(P<0.05)。结论急、慢性DILI病因药物种类相似,主要包括中成药、抗菌类药物以及镇痛解热药。与急性DILI相比,慢性DILI病例肝酶损伤严重、潜伏期长,需要激素、免疫抑制剂辅助治疗以改善患者临床转归。

关键词: 药物性肝损伤, 中成药, 免疫抑制剂

Abstract: Objective To analyze the clinical features and prognosis of acute and chronic drug induced liver injuries (DILI). Methods A total of 122 patients with DILI from January 2015 to December 2021 were included, including 79 males and 43 females, with an average age of 50 (38, 68) years old. According to the courses of diseases, the patients were divided into acute DILI (n=101) and chronic DILI (n=21) groups. The diagnosis of DILI meets the Chinese guideline for the diagnosis and treatment of DILI. The etiologies, clinical features, and clinical outcomes of acute and chronic DILI patients were compared. Results The causes of acute and chronic DILI were similar. The main causative drugs included Chinese patent medicines (78 cases, 63.9%), antibacterial drugs (15 cases, 12.3%) analgesic and antipyretic drugs (13 cases, 10.6%). Comparing the clinical features of acute and chronic DILI patients, the platelet (PLT), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of acute DILI patients were 212 (104, 376) ×10⁹/L, 276 (29, 711) U/L and 168 (18, 643) U/L, which were significantly higher than those of chronic DILI [162 (84, 235) ×10⁹/L, 80 (12, 318) U/L and 114 (10, 307) U/L, P<0.05]. the positive rates of anti-nuclear antibody (ANA) and anti-smooth muscle actin antibody (SMA) in acute DILI patients were 38 cases (37.6%) and 4 cases (4.0%), respectively, which were significantly lower than those in chronic DILI [13 cases (61.9%) and 4 cases (19.0%), P<0.05]. By analyzing the clinical outcomes of acute and chronic DILI patients, the incubation period of acute DILI patients [32 (2, 150) days] was significantly shorter than that of chronic DILI patients [44 (12, 260) days, P<0.05]. 9 cases (8.9%) and 1 case (1.0%) of patients with acute DILI were treated with steroid hormone or steroid plus immunosuppressant, and the difference was statistically significant (P<0.05) when compared with those of 8 cases (38.1%) and 5 cases (23.8%) of chronic DILI. Conclusion The causative drugs for acute and chronic DILI are similar, mainly including Chinese patent medicine, antibacterial drugs, analgesic and antipyretic drugs. Compared with acute DILI, patients with chronic DILI have severe liver enzyme abnormalities and longer latent periods, with requirement of adjuvant treatment by steroids and immunosuppressants to improve the patients' clinical outcome.

Key words: Drug-induced liver injury, Chinese patent drug, Immune inhibitor

葛文俊, 刘军, 任俊. 122例急、慢性药物性肝损伤患者临床观察[J]. 肝脏, 2023, 28(3): 343-345.

GE Wen-jun, LIU Jun, REN Jun. A clinical observation and analysis of 122 cases of acute and chronic drug-induced liver injuries[J]. Chinese Hepatolgy, 2023, 28(3): 343-345.

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