肝移植术后患者药物性肝损伤的发生及临床特点

肝脏 ›› 2020, Vol. 25 ›› Issue (8): 845-847.

肝移植术后患者药物性肝损伤的发生及临床特点

周霞, 孙艳玲, 高银杰, 贺希, 王洪波, 张达利, 刘振文, 刘鸿凌

100039 北京解放军总医院第五医学中心原肝移植中心(周霞,孙艳玲,高银杰,贺希,王洪波,张达利,刘振文,刘鸿凌)

收稿日期:2020-02-01 出版日期:2020-08-31 发布日期:2020-09-04
通讯作者: 刘振文,Email:liuzhenwen@medmail.com.cn;刘鸿凌,Email:lhl7125@sina.com
基金资助:
302医院院内课题(QNPY2015014);首都市民健康培育(Z161100000116058)

The incidence and clinical characters of drug-induced liver injury in patients after liver transplantation

ZHOU Xia, SUN Yan-ling, GAO Yin-jie, HE Xi, WANG Hong-bo, ZHANG Da-li, LIU Zhen-wen, LIU Hong-ling

Liver Transplantation Center, the Fifth Medical Center of the PLA General Hospital, Beijing 100039, China

Received:2020-02-01 Online:2020-08-31 Published:2020-09-04
Contact: LIU Zhen-wen, Email: liuzhenwen@medmail.com.cn; LIU Hong-ling, Email: lhl7125@sina.com

摘要/Abstract

摘要： 目的观察肝移植术后患者的药物性肝损伤(Drug-induced liver injury, DILI)的发生情况及临床特点。方法观察2005年1月至2015年12月在解放军总医院第五医学中心接受肝移植的患者,通过病理诊断和临床数据分析得出DILI的发生率及临床特征。结果 557例肝移植患者中有21例被确认为DILI(3.77％)。三种类型(肝细胞型、胆汁淤积型和混合型)均存在,其中胆汁淤积型为主,共11例,占52.4％。16例(76.2％)DILI患者为轻度,4例(19％)为中度。5例(23.8％)患者在移植后3个月内发病,13例(61.9％)在1年内发病。引起DILI的主要药物是免疫抑制剂,有11例(52.4％),尤其是他克莫司。其他为抗真菌药(2例,9.5％)、抗结核药(2例,9.5％)和中草药(3例,14.3％)。对症治疗后17例患者肝功能明显改善。结论肝移植术后患者DILI发生率较低,抗真菌药和他克莫司是其主要因素,病情较轻,术后1年内多见,且大多数患者的预后良好。

关键词: 肝移植, 药物性肝损伤, 发生, 临床特点

Abstract: Objective To investigate the incidence and clinical characteristics of drug-induced liver injury (DILI) in patients after liver transplantation (LTx). Methods The patients who received LTx in our center from January 2005 to December 2015 were enrolled. The pathological and clinical data were analyzed to determine the incidence and clinical characteristics of DILI in post-LTx patients. Results A total of 21 (3.77%) cases were diagnosed DILI from 557 post-LTx patients. There were 3 patterns (hepatocellular, cholestatic, and mixed), cholestatic pattern predominant (n = 11, 52.4%). Of these DILI cases, 16 (76.2%) were mild, 4 (19%) were moderate. DILI attacked in 5 cases (23.8%) within 3 months after transplantation, and in 13 cases (61.9%) within 1 year. The major agents inducing DILI were immunosuppressive agents (n = 11, 52.4%), especially tacrolimus. Besides, antifungal agents (n = 2, 9.5%), antituberculotics (n = 2, 9.5%), and Chinese herb (n = 3, 14.3%) were also causative agents. After symptomatic treatment, the liver function of 17 patients was significantly improved. Conclusion The incidence of DILI is low in patients after LTx. Antifungal drugs and tacrolimus are the main causes. The disease is relatively mild and mostly attacks within 1 year after LTx.

Key words: Liver transplantation, Drug induced liver injury, Incidence, Clinical character

周霞, 孙艳玲, 高银杰, 贺希, 王洪波, 张达利, 刘振文, 刘鸿凌. 肝移植术后患者药物性肝损伤的发生及临床特点[J]. 肝脏, 2020, 25(8): 845-847.

ZHOU Xia, SUN Yan-ling, GAO Yin-jie, HE Xi, WANG Hong-bo, ZHANG Da-li, LIU Zhen-wen, LIU Hong-ling. The incidence and clinical characters of drug-induced liver injury in patients after liver transplantation[J]. Chinese Hepatolgy, 2020, 25(8): 845-847.

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