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目的分析慢性药物性胆汁淤积性肝病(CLD)的病因、临床特点与预后。方法选择2011年1月—2013年12月北京佑安医院确诊为CLD患者34例,对其临床资料进行回顾性分析。结果引起CLD的药物主要有中草药(38.2%)、保健品或膳食添加剂(14.7%)、非甾体类抗炎药(11.8%)、抗生素(8.8%)、抗结核药(8.8%)。CLD最常见的症状是乏力23例(67.6%)和食欲减退23例(67.6%),其次为尿黄22例(64.7%),其他常见症状包括:恶心14例(41.2%),厌油7例(20.6%),呕吐6例(17.6%),皮肤瘙痒3例(8.8%),大便颜色变浅2例(5.9%)和肝区疼痛1例(2.9%)。体征:皮肤巩膜黄染24例(70.6%),皮疹和肝脾肿大各1例(2.9%)。慢性药物性胆汁淤积症患者除GGT、ALP外,ALT、AST、TBil、DBil水平显著升高。经药物治疗后ALT、TBil、GGT及ALP可恢复正常,其复常时间分别为(46.7±24.5)d、(41.9±21.4)d、(35.8±20.2)d和(40.3±22.6)d。结论中草药是导致慢性药物胆汁淤积症的重要原因。慢性药物性胆汁淤积性肝病兼具肝脏炎性反应及胆汁淤积的临床表现,经治疗后近期预后好。
Objective To analyze the etiology, clinical features and prognosis of chronic drug-induced cholestatic liver disease (CLD). Methods From January 2011 to December 2013, 34 cases of CLD were diagnosed in Beijing You’an Hospital, and their clinical data were retrospectively analyzed. Results The drugs causing CLD were mainly Chinese herbal medicine (38.2%), health products or dietary supplements (14.7%), non-steroidal anti-inflammatory drugs (11.8%), antibiotics (8.8%) and anti-tuberculosis drugs (8.8%). The most common symptoms of CLD were fatigue in 23 cases (67.6%) and loss of appetite in 23 cases (67.6%), followed by urinary yellow in 22 cases (64.7%). Other common symptoms were nausea in 14 cases (41.2%), (20.6%), vomiting in 6 cases (17.6%), pruritus in 3 cases (8.8%), stool color in 2 cases (5.9%) and hepatic pain in 1 case (2.9%). Signs: skin scleral yellow dye in 24 cases (70.6%), rash and hepatosplenomegaly in 1 case (2.9%). Chronic drug-induced cholestasis in patients with GGT, ALP, ALT, AST, TBil, DBil levels were significantly higher. ALT, TBil, GGT and ALP returned to normal after the drug treatment. The durations of their recanalization were (46.7 ± 24.5) days, (41.9 ± 21.4) days, (35.8 ± 20.2 days) and (40.3 ± 22.6 days), respectively. Conclusion Chinese herbal medicine is an important cause of chronic drug cholestasis. Chronic drug-induced cholestatic liver disease both liver inflammation and clinical manifestations of cholestasis, the prognosis after treatment is good.