抗甲状腺药物所致肝损伤的诊断与治疗原则

杨睿涛; 杨锐; 邓勋; 曾森祥; 杨晓燕

doi:10.12449/JCH240331

抗甲状腺药物所致肝损伤的诊断与治疗原则

DOI: 10.12449/JCH240331

杨睿涛¹,
杨锐^2a, , ,,
邓勋^2b,
曾森祥¹,
杨晓燕^2a

1.
南方医科大学药学院，广州 510515
2a.
南方医科大学珠江医院内分泌代谢科，广州 510262
2b.
南方医科大学珠江医院药剂科，广州 510262

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：杨锐、杨睿涛负责课题设计，资料分析，撰写论文；邓勋、曾森祥、杨晓燕参与收集数据，修改论文；杨锐负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
杨锐， yangrui91@163.com （ORCID： 0000-0002-3066-7709）

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出版历程
- 收稿日期: 2023-08-08
- 录用日期: 2023-09-05
- 出版日期: 2024-03-20

Diagnosis and treatment principles of liver injury induced by antithyroid drugs

1.
School of Pharmaceutical Sciences，Southern Medical University，Guangzhou 510515，China
2a.
Department of Endocrinology and Metabolism，Zhujiang Hospital of Southern Medical University，Guangzhou 510262，China
2b.
Pharmacy Department，Zhujiang Hospital of Southern Medical University，Guangzhou 510262，China

More Information

Corresponding author: YANG Rui， yangrui91@163.com （ORCID： 0000-0002-3066-7709）

摘要

摘要: 药物治疗是甲状腺功能亢进的主要治疗方法。抗甲状腺药物可引起肝损伤，药物性肝损伤的诊断多采用排他性诊断，诊断基于病史采集、临床症状、血清生化、影像学及组织学等。药物性肝损伤可依据肝损伤严重程度分为轻度、中度、重度和致命四种等级，轻者常不必停药，但需定期监测肝功能，重者可发生肝衰竭，病死率高，若能尽早发现、及时停药，辅以合理药物治疗，可避免致命后果。抗甲状腺药物性肝损伤的治疗原则是促进肝损伤恢复、防止肝损伤重症化、慢性化和降低死亡风险。规范用药、及时监测、早期发现和早期治疗是防治抗甲状腺药物肝损伤的重要举措。
- 药物性肝损伤 /
- 甲巯咪唑 /
- 丙硫氧嘧啶 /
- 甲状腺功能亢进症
Abstract: Pharmacotherapy is the primary treatment method for hyperthyroidism. Antithyroid drugs can induce liver injury， and the diagnosis of drug-induced liver injury is mostly exclusive based on medical history collection， clinical symptoms， serum biochemistry， radiological examination， and histology. According to the severity of liver injury， drug-induced liver injury can be classified into mild， moderate， severe， and fatal degrees. Drug withdrawal may not be necessary for patients with mild liver injury， but regular monitoring of liver function is required； in severe cases， patients may develop liver failure， which may lead to a mortality rate， and early identification， timely drug withdrawal， and reasonable pharmacotherapy can help to avoid fatal consequences. The treatment principles of liver injury induced by antithyroid drugs include promoting the recovery of liver injury， preventing the severe exacerbation and chronicity of liver injury， and reducing the risk of death. Standardized medication， timely monitoring， early identification， and early treatment are important measures for the prevention and treatment of liver injury induced by antithyroid drugs.
- Drug Induced Liver Injury /
- Methimazole /
- Propythiouracil /
- Hyperthyroidism

HTML全文

图 1 ATD肝损伤诊断和鉴别诊断流程

注：在《中国药物性肝损伤诊治指南（2023年版）》^{［ 4］}中“DILI的诊断和鉴别诊断流程图”基础上补充修订。

Figure 1. The procedure of ATD liver damage diagnosis and differential diagnosiss

下载: 全尺寸图片幻灯片

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