药物性肝损伤的临床分析(1)
摘要：目的 通过分析DILI的临床和病理特征及相关的药物类型，为患者和医疗保健人员提供药物安全信息。方法 回顾性分析2016年6月～2018年6月我院收治的126例DILI患者的临床资料，分析病因类别、临床和病理特征。结果 中药被列为126例DILI的首要原因，占54.14%。引起肝损伤中药成分大多数为何首乌、土三七，以及用于治疗骨病，关节病，皮肤病，胃病，白细胞减少症，脱发和妇科疾病的复方制剂等。西药是DILI的另一个主要原因，其中抗结核药物是DILI最主要的原因(22.22%)，其次是抗生素(7.83%)和抗甲状腺药物(3.97%)。无论中草药还是西药诱导的DILI，肝细胞性肝炎在DILI中都很普遍。结论 应明确用药风险并合理用药，以减少DILI的发生。对于来源不明的肝损伤患者，建议进行肝组织病理检查以进一步诊断。
关键词：药物性肝损伤;中药;西药;肝细胞性肝炎;病理
中图分类号：R595.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.03.041
, 百拇医药
文章编号：1006-1959(2019)03-0128-03
Abstract：Objective To provide drug safety information for patients and health care staff by analyzing the clinical and pathological features of DILI and related drug types. Methods The clinical data of 126 patients with DILI admitted to our hospital from June 2016 to June 2018 were retrospectively analyzed. The etiology， clinical and pathological features were analyzed. Results Chinese medicine was listed as the primary cause of 126 cases of DILI， accounting for 54.14%. Most of the traditional Chinese medicine ingredients causing liver damage are Heshouwu， Tusanqi， and compound preparations for treating bone diseases， joint diseases， skin diseases， stomach diseases， leukopenia， hair loss and gynecological diseases. Western medicine was another major cause of DILI， among which anti-tuberculosis drugs were the most important cause of DILI (22.22%)， antibiotics (7.83%) and anti-thyroid drugs (3.97%) were also one of the main causes of DILI. Regardless of Chinese herbal medicine or western medicine-induced DILI， hepatocellular hepatitis was common in DILI. Conclusion The risk of medication should be clarified and drug use should be rational to reduce the occurrence of DILI. For patients with liver injury of unknown origin， pathological examination of liver tissue is recommended for further diagnosis.
, 百拇医药
Key words：Drug-induced liver injury;Traditional Chinese medicine;Western medicine; Hepatocellular hepatitis;Pathology
肝臟不仅是人体重要的代谢、能量供应和免疫调节器官，也是药物代谢的主要器官[1]。 “是药三分毒”。药物在治疗剂量下尚可能损伤人体某些器官，何况是过量，而药物导致的肝脏损伤在临床也是屡见不鲜[2]。药物诱导的肝损伤(drug-induced liver injury，DILI)或肝炎是由药物引起的肝细胞炎症，可以是在治疗过程中药物本身，亦可以是其代谢产物。由于新开发药物的剂量和种类的增加，DILI有增加的趋势。我国目前报道[3]DILI发病率主要来自相关医疗机构的住院或门诊患者，其中急性DILI约占急性肝损伤住院比例的20%，然而，由于药物性肝炎临床表现的复杂性和实验室检查缺乏特异性，对于及时诊断DILI仍然是一个重大的临床挑战。为了向患者和医护人员提供有关DILI的药物安全信息，本研究回顾性分析了2016年6月～2018年6月我院感染科收治的126例DILI患者的临床资料，分析了其临床特征和相关药物的类型，现报道如下。, 百拇医药(马帅 李家斌)
关键词：药物性肝损伤;中药;西药;肝细胞性肝炎;病理
中图分类号：R595.3 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.03.041
, 百拇医药
文章编号：1006-1959(2019)03-0128-03
Abstract：Objective To provide drug safety information for patients and health care staff by analyzing the clinical and pathological features of DILI and related drug types. Methods The clinical data of 126 patients with DILI admitted to our hospital from June 2016 to June 2018 were retrospectively analyzed. The etiology， clinical and pathological features were analyzed. Results Chinese medicine was listed as the primary cause of 126 cases of DILI， accounting for 54.14%. Most of the traditional Chinese medicine ingredients causing liver damage are Heshouwu， Tusanqi， and compound preparations for treating bone diseases， joint diseases， skin diseases， stomach diseases， leukopenia， hair loss and gynecological diseases. Western medicine was another major cause of DILI， among which anti-tuberculosis drugs were the most important cause of DILI (22.22%)， antibiotics (7.83%) and anti-thyroid drugs (3.97%) were also one of the main causes of DILI. Regardless of Chinese herbal medicine or western medicine-induced DILI， hepatocellular hepatitis was common in DILI. Conclusion The risk of medication should be clarified and drug use should be rational to reduce the occurrence of DILI. For patients with liver injury of unknown origin， pathological examination of liver tissue is recommended for further diagnosis.
, 百拇医药
Key words：Drug-induced liver injury;Traditional Chinese medicine;Western medicine; Hepatocellular hepatitis;Pathology
肝臟不仅是人体重要的代谢、能量供应和免疫调节器官，也是药物代谢的主要器官[1]。 “是药三分毒”。药物在治疗剂量下尚可能损伤人体某些器官，何况是过量，而药物导致的肝脏损伤在临床也是屡见不鲜[2]。药物诱导的肝损伤(drug-induced liver injury，DILI)或肝炎是由药物引起的肝细胞炎症，可以是在治疗过程中药物本身，亦可以是其代谢产物。由于新开发药物的剂量和种类的增加，DILI有增加的趋势。我国目前报道[3]DILI发病率主要来自相关医疗机构的住院或门诊患者，其中急性DILI约占急性肝损伤住院比例的20%，然而，由于药物性肝炎临床表现的复杂性和实验室检查缺乏特异性，对于及时诊断DILI仍然是一个重大的临床挑战。为了向患者和医护人员提供有关DILI的药物安全信息，本研究回顾性分析了2016年6月～2018年6月我院感染科收治的126例DILI患者的临床资料，分析了其临床特征和相关药物的类型，现报道如下。, 百拇医药(马帅 李家斌)