Vuppalanchi Raj, Liangpunsakul Suthat, Chalasani Naga
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Am J Gastroenterol. 2007 Mar;102(3):558-62; quiz 693. doi: 10.1111/j.1572-0241.2006.01019.x.
The epidemiology of acute drug-induced liver injury (DILI) in the United States has not been well studied. We conducted a study of adults with new-onset jaundice at a nonreferral community hospital to better understand the epidemiology of acute DILI.
This is a retrospective study of adult outpatients and inpatients (> or =18 yr) with new-onset jaundice over a 5-yr period (1999-2003) at Wishard Memorial Hospital, Indiana. Patients with new-onset jaundice were identified using our electronic medical record system and individual medical records were reviewed to extract the required clinical data. New-onset jaundice was defined as the presence of total serum bilirubin >3 mg/dL in patients without a prior total bilirubin >3 mg/dL.
A total of 732 eligible adults constituted our study cohort. Sepsis or altered hemodynamic state resulting in presumed ischemic liver injury is the single most common cause of jaundice (22%). Acute liver disease as a result of nonalcoholic etiologies caused new-onset jaundice in 97 patients (13%), with acute viral hepatitis in 66 patients (9%) and DILI in 29 patients (4%). Most cases of DILI were as a result of acetaminophen toxicity with idiosyncratic DILI occurring in only five patients (0.7%). No mortality was observed at 6 wk in patients who developed idiosyncratic DILI.
Idiosyncratic DILI appears to be a rare cause of new-onset jaundice in a community hospital setting.
美国急性药物性肝损伤（DILI）的流行病学尚未得到充分研究。我们在一家非转诊社区医院对新发黄疸的成年人进行了一项研究，以更好地了解急性DILI的流行病学情况。
这是一项对印第安纳州威沙德纪念医院5年期间（1999 - 2003年）新发黄疸的成年门诊和住院患者（≥18岁）的回顾性研究。使用我们的电子病历系统识别新发黄疸患者，并查阅个人病历以提取所需的临床数据。新发黄疸定义为既往总胆红素>3 mg/dL的患者中总血清胆红素>3 mg/dL。
共有732名符合条件的成年人构成了我们的研究队列。脓毒症或血流动力学状态改变导致的疑似缺血性肝损伤是黄疸最常见的单一原因（22%）。非酒精性病因导致的急性肝病使97名患者（13%）出现新发黄疸，其中66名患者（9%）为急性病毒性肝炎，29名患者（4%）为DILI。大多数DILI病例是由对乙酰氨基酚毒性引起的，只有5名患者（0.7%）发生了特异质性DILI。发生特异质性DILI的患者在6周时未观察到死亡。
在社区医院环境中，特异质性DILI似乎是新发黄疸的罕见原因。
