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目的探讨中药引起的药物性肝损伤的临床特点。方法 2016年首都医科大学附属北京佑安医院共有114例患者因中药致药物性肝损伤,女90例,男24例,50岁以上的患者占54.4%。回顾性分析中药致药物性肝损伤患者的用药情况、临床表现、基础疾病、治疗及预后等。结果引起药物性肝损伤的药物共涉及82种中药和5种中药保健品。患者的临床表现多为尿黄(75例,65.8%)、乏力(55例,48.2%)、食欲减退(47例,41.2%)、恶心呕吐(32例,28.1%)等。服药基础疾病主要为心血管病(24例,21.1%)、皮肤病(12例,10.5%)、上呼吸道感染(12例,10.5%)、骨关节病(11例,9.6%)等。肝损伤分型以混合型(49例,43.0%)最多,其次是肝细胞损伤型(43例,37.7%),第3位是胆汁淤积型(22例,19.3%)。经停药和保肝治疗后,83例治愈,30例好转,1例死亡。结论引起药物性肝损伤的中药种类较多,呈现多种临床表现形式,通常预后较好。但临床医生应重视中药所致药物性肝损伤。
Objective To investigate the clinical characteristics of drug-induced liver injury caused by traditional Chinese medicine. METHODS: A total of 114 patients with drug-induced liver injury caused by Chinese herbs were enrolled in this study. There were 90 males and 24 females, accounting for 54.4% of all patients over the age of 50 in Beijing You’an Hospital, Capital Medical University in 2016. Retrospective analysis of Chinese medicine-induced drug-induced liver injury in patients with medication, clinical manifestations, underlying diseases, treatment and prognosis. Results Drug-induced liver injury involving a total of 82 kinds of traditional Chinese medicine and five kinds of traditional Chinese medicine health products. The clinical manifestations of patients were mostly urinary yellow (75 cases, 65.8%), fatigue (55 cases, 48.2%), loss of appetite (47 cases, 41.2%) and nausea and vomiting (32 cases, 28.1%). The main underlying diseases were cardiovascular disease (24 cases, 21.1%), dermatosis (12 cases, 10.5%), upper respiratory tract infection (12 cases, 10.5%) and osteoarthrosis (11 cases, 9.6%). Hepatocellular carcinoma (HCC) was the most common type of hepatocellular carcinoma (49 cases, 43.0%), followed by hepatocellular injury (43 cases, 37.7%) and cholestasis type 3 (22 cases, 19.3%). After the withdrawal and hepatoprotective therapy, 83 cases were cured, 30 cases improved and 1 case died. Conclusion There are many types of traditional Chinese medicine that cause drug-induced liver injury, presenting with various clinical manifestations, usually with good prognosis. However, clinicians should pay attention to drug-induced liver injury caused by traditional Chinese medicine.