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儿童药物性肝损伤的用药分析及临床特征
Drug-induced liver injury in children: An analysis of medication and clinical features
文章发布日期:2019年03月08日  来源:  作者:张艳芳,郭玉明,牛 明,等  点击次数:198次  下载次数:60次

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【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=11658, P=0.003)和潜伏期(H=10.945, P=0.004)差异均有统计学意义,中药组比其他两组的用药时间和潜伏期更长,差异均有统计学意义(P值均<0.05)。结论儿童DILI多数比较严重,应高度重视儿童用药的肝损伤风险,尤其对抗菌药、解热镇痛抗炎药以及治疗皮肤病的部分中药的长期用药肝损伤风险应加以重点防控。
【Abstract】:ObjectiveTo investigate the drugs responsible for drug-induced liver injury (DILI) in children and related risk factors, and to provide a reference for safe drug use in children in clinical practice. MethodsA retrospective analysis was performed for the clinical data of 187 children with DILI, aged 0-14 years, who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January 2008 to December 2017, including medication history, biochemical parameters, symptoms/signs, and clinical outcome. Based on the method of integrated evidence chain, 127 children with medication information were divided into Western medicine-induced DILI group (Western medicine group with 75 children), traditional Chinese medicine (TCM)-induced DILI group (TCM group with 15 children), and the group 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 comparison of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. ResultsOf 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, analgesics, and anti-inflammatory drugs, which accounted for 42%, 30%, 56%, and 31%, respectively. In the TCM group, the most common TCM drugs for DILI were those used to treat skin diseases, which accounted for 47% and were mainly the preparations of Fallopia multiflora (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). ConclusionMost children with DILI have serious conditions. The risk of liver injury due to medication in children should be taken seriously, and particular emphasis should be placed on the risk of liver injury caused by antibiotics, antipyretics, analgesics, and anti-inflammatory drugs and long-term use of some TCM drugs for skin diseases.
【关键字】:药物性肝损伤; 儿童; 用药分析
【Key words】:drug-induced liver injury; children; medication analysis
【引证本文】:ZHANG YF, GUO YM, NIU M, et al. Drug-induced liver injury in children: An analysis of medication and clinical features[J]. J Clin Hepatol, 2019, 35(3): 579-584. (in Chinese)
张艳芳, 郭玉明, 牛明, 等. 儿童药物性肝损伤的用药分析及临床特征[J]. 临床肝胆病杂志, 2019, 35(3): 579-584.

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