242例药物性肝病临床特点分析
谢 敏 王 彤 张春兰 范慧敏 刘玉萍 雷春亮

摘 要 目的：对242例药物性肝病（DILD）的病因，临床特点及发病规律进行分析，以提高临床医师对该病的认识。方法：将1999年1月至2004年12月收治住院的242例确诊为DILD患者的资料进行回顾性分析。结果：DILD发病率呈上升趋势,占同期急性肝炎的14.33%。引起此病的药物种类多，其中抗结核药占30.58%，抗肿瘤药站21.49%，中药占17.77%；用药4到12周出现肝损害占55.79%。临床以急性或亚急性起病占94.63%，主要表现为乏力、恶心、呕吐、尿黄、身目黄染及肝大等。肝功能损伤除ALT、AST及TB升高外，还有GGT及ALP明显升高，且较ALT、AST及TB恢复慢的特点。部分合并多脏器功能衰竭。经综合治疗后，83.88%治愈或好转，8.68%无变化或加重，7.44%死亡。结论：DILD发病率上升，涉及药物种类多，临床表现与病毒性肝病相似，无特异性；但病死率较高，应引起重视。临床上一旦明确诊断应立即停用相关药物并进行综合治疗，如出现肝功能衰竭应及时应用人工肝支持系统(ALSS)治疗，必要时进行肝移植术。
关键词 药物性肝病 临床特点 综合分析

Clinical analysis of 242 cases of drug-induced liver damage
XIE Min, WANG Tong, ZHANG Chun lan, FAN Hui min, LIU Yu Ping, LEI Chun liang
Department of 1st Lliver Disease of the Eighth People''''s Hospital of Guangzhou, Guangdong510060,China.

Abstract Objectives: By analyzing the etiology, clinical features and characters of disease onset of 242 drug-induced liver damage (DILD) to improve the understanding of this disease. Methods: 242 cases of DILD admitted from January, 1999 to December, 2004 were retrospectively analyzed. Results: The incidence of DILD showed a increasing tendency in the last several years. It accounted for 14.33% of the acute hepatitis admitted at the same period of time. A variety of drugs can cause DILD, among them anti-tuberculosis drugs account for 30.58%, chemotherapeutic drugs for 21.49% and Chinese traditional herbal drugs for 17.77%. 55.78% Liver damage was present between 4 to 12 weeks after drug administration . 94.63% of cases showed an acute or subacute onset with the main clinical features of enervation, nausea, vomiting, yellowish urine, jaundice and enlarged liver. Liver function damage was featured by elevation of serum ALT, AST, GGT, ALP, TB. There is marked elevation of GGT and ALP and this frequently indicates a slower recovery than ALT,AST and TB. Part of the patients were complicated with multiple organs failure. Through comprehensive treatment, 83.88% of the cases were cured or showed improvement, 8.68% showed no changes and 7.44% died of the disease. Conclusions: There is a trend of increase in the incidence of DILD in recent years. It can be induced by a variety of drugs. The clinical features are similar to those of viral hepatitis with no specificity. 　　　DILD has a rather high mortality and therefore needs attention. Once the diagnosis is established, immediate termination of administration the suspicious drugs is necessary and comprehensive treatment should be used. Artificial Liver Support System(ALSS) should be considered when liver function failure develops, liver transplantation should be used in necessary.
　　Key words drug-induced liver damage Clinical feauures Meta－analysis