儿童药物性肝损伤的用药分析及临床特征

张艳芳; 郭玉明; 牛明; 葛斐林; 景婧; 朱云; 朱世殊; 韩紫欣; 王伽伯; 刘士敬; 肖小河

doi:10.3969/j.issn.1001-5256.2019.03.025

儿童药物性肝损伤的用药分析及临床特征

DOI: 10.3969/j.issn.1001-5256.2019.03.025

1. 承德医学院
2. 解放军总医院第五医学中心全军中医药研究所
3. 解放军总医院第五医学中心中西医结合诊疗与研究中心
4. 解放军总医院第五医学中心青少年肝病科

基金项目:

基于临床病证的传统无毒中药肝毒性客观辨识及机制研究(81630100)；国家中医药管理局中医药行业科研专项(201507004-4-2)；国家“重大新药创制”科技重大专项(2015ZX09501-004-001-008)；

详细信息

中图分类号: R725.7
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出版历程
- 出版日期: 2019-03-20

Drug-induced liver injury in children:An analysis of medication and clinical features

Chengde Medical College

Research funding:

摘要

摘要:
目的探讨导致儿童药物性肝损伤（DILI）的损肝药物及其发生的相关危险因素,为儿童临床安全用药提供参考。方法对解放军总医院第五医学中心2008年1月-2017年12月187例0～14岁儿童DILI的用药史、生化指标、症状体征及临床转归等进行回顾性分析。采用整合证据链法将其中127例可获取用药信息的DILI病例分为西药致DILI组（西药组,n=75）、中药致DILI组（中药组,n=15）及中西药联用致DILI组（中西药联用组,n=37）。比较不同组间的用药原因、用药时间和潜伏期、药物分类的差异。偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Nemenyi检验,计数资料组间比较采用χ2检验。结果重度及重度以上肝损伤的儿童DILI有116例,占全部病例的62%（116/187）,其中肝移植3例,死亡1例,45例（24%）发生慢性化。西药组和中西药联用组的可疑损肝西药均以抗菌药和解热镇痛抗炎药为主,分别占各组的42%和30%、56%和31%。中药组的可疑损肝药物以治疗皮肤病的中药为主,占中药组的47%,且主要为何首乌制剂（33%）。3组间用药时间（H=1...
- 药物性肝损伤 /
- 儿童 /
- 用药分析
Abstract:
Objective To investigate the drugs responsible for drug-induced liver injury ( DILI) in children and related risk factors, andto provide a reference for safe drug use in children in clinical practice. Methods A retrospective analysis was performed for the clinical da-ta of 187 children with DILI, aged 0-14 years, who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January2008 to December 2017, including medication history, biochemical parameters, symptoms/signs, and clinical outcome. Based on the meth-od of integrated evidence chain, 127 children with medication information were divided into Western medicine-induced DILI group ( West-ern medicine group with 75 children) , traditional Chinese medicine ( TCM) -induced DILI group ( TCM group with 15 children) , and thegroup with DILI induced by Western medicine and TCM ( TCM-Western medicine group with 37 children) . The reason for medication, medication time, latency of DILI, and drug classification were compared between groups. The Kruskal-Wallis H test was used for compari-son of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between twogroups; the chi-square test was used for comparison of categorical data between groups. Results Of all 187 children with DILI, 116 ( 62%) had severe liver injury or above, among whom 3 underwent liver transplantation and 1 died, and 45 ( 24%) developed chronicity.In the Western medicine group and the TCM-Western medicine group, major suspected drugs for DILI were antibiotics, antipyretics, anal-gesics, and anti-inflammatory drugs, which accounted for 42%, 30%, 56%, and 31%, respectively. In the TCM group, the most com-mon TCM drugs for DILI were those used to treat skin diseases, which accounted for 47% and were mainly the preparations of Fallopia multi-flora ( 33%) . There were significant differences between the three groups in medication time ( H = 11. 658, P = 0. 003) and latency ( H =10. 945, P = 0. 004) , and the TCM group had significantly longer medication time and latency than the other two groups ( all P < 0. 05) .Conclusion Most children with DILI have serious conditions. The risk of liver injury due to medication in children should be taken serious-ly, and particular emphasis should be placed on the risk of liver injury caused by antibiotics, antipyretics, analgesics, and anti-inflamma-tory drugs and long-term use of some TCM drugs for skin diseases.
- drug-induced liver injury /
- children /
- medication analysis

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5.	朱世殊，董漪. 儿童药物性肝损伤的诊断与鉴别诊断. 中国实用儿科杂志. 2022(07): 496-500 . 百度学术
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