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The natural history of histologically proved drug induced liverdisease

机译：经组织学证实为药物性肝的自然病史疾病

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摘要

BACKGROUND—The long term outcome of drug related liver disease is unknown.
AIMS—To study the natural history of histologically proved drug induced hepatotoxicity.
METHODS—110 patients with liver biopsies coded either as drug induced liver disease or hepatitis/cholestasis of unknown aetiology were identified from hospital records 1978-1996. Review of case notes and histology identified 44 patients with definite drug induced hepatotoxicity. Forty surviving patients were invited to attend a follow up clinic. History, examination, full liver screen, and isotope and ultrasound liver scans were repeated in all patients. Repeat liver biopsies were offered to patients with abnormal liver tests.
RESULTS—Presentation at index biopsy was jaundice in 24 patients, abnormal liver tests in 17, and hepatic failure in three. Antibiotics (n=13) and non-steroidal anti-inflammatory drugs (n=11) were the most common drugs implicated.Initial histology showed acute hepatitis in six, chronic hepatitis in20, and cholestasis in 18. At 1-19 years (median 5 years) follow up,13/33 (39%) patients had persistent significant abnormalities in theirliver blood tests and/or scans. Three of the five repeat liver biopsiesperformed showed significant abnormalities. Factors predictingpersistence or development of chronic liver disease were fibrosis andcontinued exposure to the drug.
CONCLUSIONS—Drugs should beconsidered in the differential diagnosis of abnormal liver functionand/or histology, as failure to withdraw the offending drug isassociated with a high risk of persistent liver damage.

Keywords:drugs; chronic active hepatitis; toxic hepatitis; diclofenac
机译：背景—药物相关性肝病的长期结果尚不清楚。
目标-研究经组织学证实的药物诱发的肝毒性的自然史。
方法-从1978-1996年的医院记录中识别出110例肝活检患者，其编码为药物性肝病或病因不明的肝炎/胆汁淤积。回顾病例笔记和组织学，确定了44例具有明确药物诱发的肝毒性的患者。邀请了40名幸存的患者前往随访诊所。所有患者均重复病史，检查，全肝筛查以及同位素和超声肝扫描。对于肝功能异常的患者，应再次进行肝活检。
结果-活检的表现为黄疸24例，肝脏检查异常17例，肝衰竭3例。抗生素（n = 13）和非甾体类抗炎药（n = 11）是最常见的药物。最初的组织学显示，急性肝炎占6个，慢性肝炎占6个。20例，胆汁淤积18例。在1-19年（中位数5年）随访，13/33（39％）的患者持续存在明显的异常肝血检查和/或扫描。五个重复的肝活检中有三个表现为明显异常。因素预测慢性肝病的持续或发展为纤维化和持续接触药物。
结论—毒品应在鉴别肝功能异常中应考虑和/或组织学，因为未能撤回违规药物与持续性肝损害的高风险相关。

关键字：毒品;慢性活动性肝炎中毒性肝炎双氯芬酸

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