The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice
The long-term follow-up after idiosyncratic drug-induced liver injury with jaundice
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DOI：
10.1016/j.jhep.2008.10.021
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发表时间：
2009-03-01
影响因子：
25.7
通讯作者：
Davidsdottir, Loa
中科院分区：
文献类型：
--
作者：
Bjornsson, Einar;Davidsdottir, Loa
背景/目的：药物性肝损伤（DILI）后的慢性演变已有报道。方法：DILI和伴随黄疸存活的患者向瑞典药物不良反应咨询委员会报告，（1970-2004年）与瑞典医院出院和死亡原因登记有关。在712名幸存者中，27名无法检索，但685名患者可与登记处联系，392名女性（57.2%）和293名男性（42.8%），中位年龄58岁（41-74岁），平均随访10年。共有23/685例（3.41%）患者因肝病住院，5例发生肝脏相关死亡。8例患者发展为肝硬化（7例失代偿，5例死亡），5例为“隐源性”肝硬化，其中DILI可能在这种发展中发挥了作用。在有肝脏相关发病率/死亡率的患者中，DILI前的治疗持续时间较长（135 +/- 31天vs. 53 +/- 3; p < 0.0001）。5/23（22%）的自身免疫性肝炎，所有的女性性别后，平均5.8 years.Conclusions：严重DILI后黄疸临床重要的肝脏疾病的发展是罕见的急性DILI后。然而，失代偿性“隐源性”肝硬化在一些患者中发展为致死性结局，其中DILI可能在这种发展中发挥了作用。(C)2008年欧洲肝脏研究协会。由Elsevier BN出版。All rights reserved.
Background/Aims: Chronic evolution after drug-induced liver injury (DILI) has been reported. How often this leads to liver-related morbidity and mortality is unexplored.Methods: Patients who survived DILI and concomitant jaundice reported to the Swedish Adverse Drug Reaction Advisory Committee (1970-2004) were linked to the Swedish Hospital Discharge and Cause of Death Registries.Results: Among the 712 survivors, 27 could not be retrieved but 685 patients could be linked to the registries, 392 females (57.2%) and 293 males (42.8%) median age 58 (41-74), a mean follow-up of 10 years. A total of 23/685 (3.41%) patients had been hospitalized for liver disease and 5 had liver-related mortality. Eight patients developed cirrhosis (7 decompensated, 5 died), 5 had "cryptogenic" cirrhosis in which DILI might have played a role in this development. Duration of therapy before DILI was longer in patients with liver-related morbidity/mortality (135 +/- 31 days vs. 53 +/- 3; p < 0.0001). Autoimmune hepatitis developed in 5/23 (22%), all of female gender after a mean of 5.8 years.Conclusions: Development of clinically important liver disease after severe DILI associated with jaundice is rare after acute DILI. However decompensated "cryptogenic" cirrhosis developed in some patients with fatal outcome in which DILI might have played a role in this development. (C) 2008 European Association for the Study of the Liver. Published by Elsevier BN. All rights reserved.