药物性肝衰竭临床特点及预后有关因素分析

目的：探讨药物性肝衰竭的病因、临床特征及预后相关因素,提高对药物性肝衰竭的认识,减少不良事件发生的几率。方法：对2007年1月至2011年12月我院56例药物性肝衰竭患者进行回顾性分析,对患者用药情况、临床表现、肝衰竭的分型、并发症的发生、生化指标的特点及治疗与预后进行相关性分析。结果：导致肝衰竭前三位的药物分别是中药占30.3%、抗结核药占26.8%和非甾体类抗炎药占23.2%。发病时常见的临床表现为乏力64.2%、纳差60.7%、尿黄60.7%。并发症发生率最高的是感染73.2%、其次为肝性脑病66.1%、腹水64.3%。感染部位以腹腔最常见,占46.4%,其次为肺部41%。治愈好转者为18例（26.2%）,治疗无效者14例（25.0%）;死亡者为24例（42.9%）。从患者发病到死亡的中位时间为35天。治愈好转组的肝性脑病和消化道出血的发生率明显低于无效死亡组,激素治疗与好的预后密切相关（P〈0.05）。结论：药物性肝衰竭的主要致病药物有中药、抗结核药和解热镇痛药。患者的临床表现无明显特异性,肝性脑病和消化道出血一旦出现提示预后差。在疾病早期采用适当的激素治疗,可以明显改善肝衰竭患者的预后。

Clinical Features and Relative Prognosis Factors of 56 Patients with Drug-Induced Liver Failure

Objective： To investigate the clinical features and prognosis factors of patients with drug-induced liver failure（DILF）and to raise the awareness of drug-induced liver failure and reduce the probability of occurrence of adverse events. Methods： The clinical data of 56 DILF patients who were admitted to our hospital from Jan. 2007 to Dec. 2011 were reviewed, and the drug use, clinical manifestations, complications, biochemical factors, treatments and prognosis of those patients were analyzed. Results： The mainly 3 kinds of drugs causing DILF were herbal medicines（30.3%）,anti-tuberculosis drugs（26.8%） and Non steroidal anti-inflammatory drugs（23.2%）.The common clinical manifestations was fatigue（64.2%）, anorexia（60.7%）, yellow urine（60.7%）. The 3 tops underlying complications were infection（73.2%）, hepatic encephalopathy（66.1%）, ascites（64.3%）. Abdominal cavity and pulmonary was the main position of infection, 46.4%and 41% respectively. A total of 18 cases（26.2%） of the patients were cured and improved, 14 cases（25.0%） of the patients were invalid, and 24 cases（42.9%） of the patients were dead. From the time when the patients had clinical manifestations or the abnormal liver function to died, the medium time was 35 days. The rate of hepatic encephalopathy and gastrointestinal bleeding was much lower in the cured and improved group than that in the invalid and dead group. Treating DILF used glucocorticoids were significantly relative to the better prognosis（P0.05）. Conclusion： The drugs casing DILF mainly are herbal medicines, anti-tuberculosis drugs and analgesic drugs. The clinical features are not specific, hepatic encephalopathy and gastrointestinal bleeding are related to the bad prognosis. In the early phase of DILF, glucocorticoids use can significantly improve the prognosis.