药物相关胆管消失综合征的研究进展

许姗姗; 仇丽霞; 宋静静; 张晶

doi:10.3969/j.issn.1001-5256.2021.08.051

药物相关胆管消失综合征的研究进展

DOI: 10.3969/j.issn.1001-5256.2021.08.051

许姗姗^{1, 2},
仇丽霞¹,
宋静静¹,
张晶^1, ,

1.
首都医科大学附属北京佑安医院肝病中心三科，北京 100069
2.
北京大学国际医院感染肝病部，北京 102206

基金项目:

佑安肝病艾滋病基金科研课题 (YNKTTS20180115)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：许姗姗负责资料收集、分析，拟定写作思路，撰写论文；仇丽霞、宋静静参与资料收集；张晶负责指导撰写文章并最后定稿。

详细信息

通信作者:
张晶，drzhangjing@163.com

中图分类号: R575.7
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出版历程
- 收稿日期: 2020-12-21
- 录用日期: 2021-01-19
- 出版日期: 2021-08-20

Research advances in drug-induced vanishing bile duct syndrome

1.
Third Department of Liver Disease Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
2.
Department of Infectious Liver Diseases, Peking University International Hospital, Beijing 102206, China

Research funding:

The Scientific Research Project of YouAn Liver Disease AIDS Fund (YNKTTS20180115)

摘要

摘要: 据目前研究表明，药物性肝损伤已成为临床急性肝损伤的常见原因之一。胆管消失综合征(VBDS)是指肝内胆管局灶性或弥漫性消失，临床表现以胆汁淤积为特点的综合征，药物相关胆管消失综合征(D-VBDS)是其重要病因之一。多数D-VBDS患者预后较好，但部分患者可进展为肝硬化、肝衰竭。通过回顾分析D-VBDS的临床诊疗进展，认为D-VBDS诊断困难、治疗方法有限、部分患者预后较差，临床上需谨慎应用药物以减少其发病率和病死率。
- 胆管消失综合征 /
- 化学性与药物性肝损伤 /
- 病理学, 临床 /
- 治疗学
Abstract: Current evidence shows that drug-induced liver injury has become one of the common causes of acute liver injury in clinical practice. Vanishing bile duct syndrome (VBDS) refers to a syndrome of focal or diffuse disappearance of intrahepatic bile ducts characterized by cholestasis, and drug-induced VBDS (D-VBDS) is one of the important causes of this disease. Most patients with D-VBDS have a good prognosis, but some patients may progress to liver cirrhosis and liver failure. By reviewing the advances in the clinical diagnosis and treatment of D-VBDS, this article points out the difficulty in the diagnosis of D-VBDS, the limited treatment methods for this disease, and poor prognosis in some patients. Therefore, drugs should be used with caution in clinical practice to reduce the incidence and mortality rates of D-VBDS.
- Vanishing Bile Duct Syndrome /
- Chemical and Drug Induced Liver Injury /
- Pathology, Clinical /
- Therapeutics

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表 1 导致VBDS的药物

药物分类	具体药物
抗感染药	替莫唑胺^[5-6]、美罗培南^[7-8]、甲氧苄啶-磺胺甲恶唑^{[4, 9-11]}、阿莫西林^{[1, 6, 12]}、阿莫西林-克拉维酸钾^{[1, 4]}、阿奇霉素^{[1, 3]}、氨苄青霉素^[4]、复方新诺明^[4]、克林霉素^{[1, 4]}、头孢氨苄^[4]、头孢唑林^[4]、红霉素^{[1, 4]}、氟喹诺酮^{[4, 13]}、莫西沙星^[14]、四环素^[4]、阿托伐醌/氯胍^[15]联合用药：头孢菌素+甲硝唑+克霉唑^[16]
非甾体消炎药	布洛芬^{[1, 4, 17-19]}、对乙酰氨基酚^[1]、洛索洛芬^[20]
抗精神药	丙戊酸^[21]、卡马西平^{[1, 4]}、阿米替林^[4]、丙米嗪^[4]、安定^[4]、拉莫三嗪^{[1, 22]}、舍曲林^[23-24]
降糖药	阿托伐他汀^[1]、非诺贝特^[1]
降脂药	格列本脲^[4]
质子泵抑制剂^[25]	奥美拉唑^[1]
中草药(包括中药和中成药)^[25-26]	治疗骨关节病、风湿性关节炎、椎间盘膨出、镇静安神、皮肤病的中药^[27]
抗肿瘤药	英夫利昔单抗^[28]联合用药：培西达替尼和紫杉醇^[29]
其他	西咪替丁^[4]、硫唑嘌呤^[4]、胃复安^[1]联合药物：阿奇霉素+布洛芬+中成药物^[30]

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