【摘要】 目的 探讨重症药物性肝损伤患者的临床特征。方法 收集2018年9月至2021年9月于郑州大学第一附属医院住院的287例重症药物性肝损伤患者的临床表现、可疑药物、肝功能、年龄、性别等，比较不同临床类型重症药物性肝损伤患者临床特点、肝功能变化。结果 (1)重症药物性肝损伤临床表现以黄疸最为常见(51.716%),引起肝损伤药物以中药为主(44.251%)。(2)不同临床类型重症药物性肝损伤基线谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)差异有统计学意义(P<0.001),肝细胞损伤型与混合型基线ALT、AST差异无统计学意义，但与胆汁淤积型、肝生化异常差异具有统计学意义(P<0.001)。胆汁淤积型与混合型基线ALP差异无统计学意义，但与肝细胞损伤型、肝生化异常具差异有统计学意义(P<0.001)。(3)不同临床类型重症药物性肝损伤基线直接胆红素(DBIL)、间接胆红素(IBIL)、总胆红素(TBIL)差异无统计学意义(P>0.05),肝细胞损伤型与胆汁淤积型TBIL、DBIL较基线下降30%、50%所需时间差异有统计学意义(P<0.05)。结论 重症药物性肝损伤临床表现以黄疸为主，中药是引起肝损伤最常见药物，肝细胞损伤型以ALT、AST升高为主，胆汁淤积型主要为ALP升高，混合型AST、ALT、ALP均升高，肝细胞损伤型DBIL、TBIL下降较胆汁淤积型更快。更多还原

【Abstract】 Objective To investigate the clinical characteristics of patients with severe drug-induced liver injury.Methods A total of 287 patients with severe drug-induced liver injury who were hospitalized in the First Affiliated Hospital of Zhengzhou University from September 2018 to September 2021 were collected with clinical manifestations, suspected drugs, liver function, age, gender, etc. The clinical characteristics and liver function were compared.Results(1) Jaundice was the most common clinical manifestation of severe drug-induced liver injury(51.716%), Chinese medicine was the main drug causing liver injury(44.251%).(2) Baseline alanine transaminase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP) of different clinical types of severe drug-induced liver injury were statistically significant differences(P<0.001). There were no statistical differences in ALT and AST between the hepatocellular injury type and the mixed type, but there were statistically significant differences between the hepatocellular injury type and cholestatic type, liver biochemical abnormalities type(P<0.001). There was no statistical differences in baseline ALP between the cholestatic type and the mixed type, but there were statistically significant differences between the cholestatic type and hepatocellular injury type, liver biochemical abnormalities type(P<0.001).(3) There were no statistical differences in direct bilirubin(DBIL), indirect bilirubin(IBIL), total bilirubin(TBIL) between different clinical types of severe drug-induced liver injury(P>0.05), and the time of TBIL, DBIL of hepatocellular injury type and cholestatic type decreased 30%, 50% from baseline was statistical differences(P<0.05).Conclusion The clinical manifestations of severe drug-induced liver injury is jaundice, Chinese medicine is the most common drug to cause liver injury. In the hepatocyte injury type, ALT and AST are mainly increased. In the cholestatic type, ALP is mainly increased. In the mixed type, AST, ALT and ALP are all increased. In the hepatocyte injury type, DBIL and TBIL decrease faster than that in the cholestatic type.更多还原