Department of Infectious Diseases and Center for Liver Diseases, Peking University First Hospital, No. 8, XiShiKu Street, XiCheng District, Beijing 100034, China.
Cell Biochem Biophys. 2012 Nov;64(2):77-83. doi: 10.1007/s12013-012-9373-y.
We investigated clinical features, therapy, and outcomes of patients hospitalized for drug-induced liver injury (DILI). DILI resolution was defined as liver biochemistry values back to normal or lower than CIOMS laboratory criteria; Chronicity was defined as persistent biochemical abnormality for >6 months after drugs' withdrawal. Three-hundred cases were reviewed retrospectively; mean age 51 (13-86) years, and 204 (68 %) were females. It included 267 (89 %) hepatocellular injury, 16 (5.3 %) cholestatic injury, and 17 (5.7 %) mixed injury cases. In hepatocellular injury group, 197 (73.8 %) patients with TBIL < 10× ULN included 142 (72.1 %) females and 70 (26.2 %) patients with TBIL ≥ 10× ULN included 39 (55.7 %) females (P = 0.012). Of 70 patients (TBIL ≥ 10× ULN), 20 were treated with steroid step-down therapy (79 ± 26 days) and others with non-steroid therapy. The steroid therapy group showed higher DILI resolution rate (P = 0.029) and shorter recovery time (P = 0.012). Notably, 274/300 (91.3 %) patients resolved, 18/300 (6 %) developed chronic liver injury, 7/300 (2.3 %) died, and one patient received liver transplantation. In death group, TBIL, ALB, PT, and PTA revealed more severe abnormality than in recovery group. In 121/300 (40.3 %) patients, use of herbal medicines was the leading cause of liver injury, followed by antibiotics, cardiovascular drugs, and endocrine drugs. We concluded that step-down steroid therapy for DILI improved curative effect, shortened disease course, and was safe.
我们研究了因药物性肝损伤（DILI）住院患者的临床特征、治疗方法和转归。DILI 缓解定义为肝功能生化指标恢复正常或低于 CIOMS 实验室标准；慢性定义为停药后 6 个月以上持续生化异常。回顾性分析 300 例患者；平均年龄 51（13-86）岁，204 例（68%）为女性。包括 267 例（89%）肝细胞损伤，16 例（5.3%）胆汁淤积性损伤和 17 例（5.7%）混合性损伤。在肝细胞损伤组中，197 例（73.8%）总胆红素（TBIL）<10×正常值上限（ULN）的患者中，142 例（72.1%）为女性，70 例（26.2%）TBIL≥10×ULN 的患者中，39 例（55.7%）为女性（P=0.012）。在 70 例（TBIL≥10×ULN）患者中，20 例接受激素逐渐减量治疗（79±26 天），其余接受非激素治疗。激素治疗组 DILI 缓解率更高（P=0.029），恢复时间更短（P=0.012）。值得注意的是，300 例患者中 274 例（91.3%）缓解，18 例（6%）发生慢性肝损伤，7 例（2.3%）死亡，1 例接受肝移植。在死亡组中，TBIL、白蛋白（ALB）、凝血酶原时间（PT）和凝血酶原活动度（PTA）的异常程度较恢复组更为严重。在 121 例（40.3%）患者中，草药是导致肝损伤的主要原因，其次是抗生素、心血管药物和内分泌药物。我们得出结论，DILI 的激素逐渐减量治疗可提高疗效，缩短病程，且安全。
