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2820例药物性肝损伤临床分析

[Clinical analysis of 2 820 cases of drug-induced liver injury].

作者信息

Song F J, Zhai Q H, He Q J, Lyu S, Zhu B, Xu T J, Tian H, Xin S J, You S L

机构信息

Liver Failure Treatment and Research Center, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China.

Qingdao Eighth People's Hospital, Qingdao 26100, China.

出版信息

Zhonghua Gan Zang Bing Za Zhi. 2020 Nov 20;28(11):954-958. doi: 10.3760/cma.j.cn501113-20200609-00305.

Abstract

To investigate the clinical characteristics, incidence trend, underlying diseases, causative drug and prognosis of drug-induced liver injury (DILI), so as to provide basis for its prevention and treatment. A retrospective study was conducted on 2 820 DILI cases who were admitted to our hospital from January 2002 to December 2015, and their clinical characteristics, incidence trends, underlying related diseases, causative drug, treatment and outcome were analyzed. Among 2 820 DILI cases, the ratio of male to female was 1:1.44, and the age was (44.00±16.32) years old. According to the clinical classification of DILI, there were 2 353 cases (83.43%) of hepatocyte injury, 353 cases (12.51%) of cholestatic type and 114 cases (4.04%) of mixed type. In the three clinical classification of DILI, there was no statistically significant difference in the ratio of male to female (χ(2) = 3.032, > 0.05). However, the difference in the ratio of male to female between different age groups was statistically significant (χ(2) = 48.367, < 0.001). Among the patients with liver disease and acute liver disease admitted to our hospital from January 2002 to December 2015, the proportion of DILI and acute DILI showed an overall upward trend. The main underlying related diseases of 2 820 DILI cases were fever (15.14%), skin diseases (11.84%), cardiovascular and cerebrovascular diseases (11.17%). Chinese herbal patent medicines (37.49%), antibiotics (15.85%), antipyretic-analgesics (14.37%), and so on were the main causative drugs involved, and the prognostic differences among the three clinical classifications of DILI in terms of cure, improvement, ineffectiveness, and death were statistically significant ( = 61.300, < 0.001). In recent years, among the patients with liver disease in our hospital, the proportion of DILI has shown an obvious upward trend, involving a variety of underlying diseases and causative drugs, and thus it needs clinical attention.

摘要

探讨药物性肝损伤(DILI)的临床特点、发病趋势、基础疾病、致病药物及预后,为其防治提供依据。对2002年1月至2015年12月我院收治的2820例DILI患者进行回顾性研究,分析其临床特点、发病趋势、相关基础疾病、致病药物、治疗及转归情况。2820例DILI患者中,男女比例为1∶1.44,年龄为(44.00±16.32)岁。按照DILI临床分型,肝细胞损伤型2353例(83.43%),胆汁淤积型353例(12.51%),混合型114例(4.04%)。在DILI的三种临床分型中,男女比例差异无统计学意义(χ(2)=3.032,P>0.05)。但不同年龄组男女比例差异有统计学意义(χ(2)=48.367,P<0.001)。2002年1月至2015年12月我院肝病及急性肝病患者中,DILI及急性DILI所占比例呈总体上升趋势。2820例DILI患者的主要相关基础疾病为发热(15.14%)、皮肤病(11.84%)、心脑血管疾病(11.17%)。主要致病药物涉及中成药(37.49%)、抗生素(15.85%)、解热镇痛药(14.37%)等,DILI三种临床分型在治愈、好转、无效及死亡方面的预后差异有统计学意义(P=61.300,P<0.001)。近年来,我院肝病患者中DILI所占比例呈明显上升趋势,涉及多种基础疾病及致病药物,需临床关注。

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