70例儿童药物性肝损伤用药分析

doi:10.19803/j.1672-8629.2020.07.10

摘要/Abstract

摘要： 目的探讨儿童药物性肝损伤（drug-induced liver injury, DILI）临床特点、致病药物以及药物治疗情况,为提高临床合理用药水平提供参考。方法对2015年1月至2019年5月我院收治的70例药物性肝损伤病例进行回顾性分析。结果 70例儿童DILI,男：女为2.04：1,1月~1岁患儿最多。40%患儿表现为无症状,有临床症状者多表现无特异性,以发热、乏力、纳差为主。临床分型以肝细胞损伤型最多（52.86%）,胆汁淤积型次之（28.57%）,混合型最少（18.57%）。70例中,解热镇痛药引起者21例占30.00%,抗菌药物引起者13例,占24.29%,抗病毒药物12例,占17.14%。联苯双酯、还原型谷胱甘肽、复方二氯醋酸二异丙胺作为治疗用药在临床上使用较多。儿童DILI治疗用药分析显示,二联及以上用药者共66例,占94.29%。存在联苯双酯用法用量错误、复方甘草酸苷粉针及多烯磷脂酰胆碱注射液溶剂不合理、门冬氨酸钾镁药物浓度不当等用药不合理现象。结论解热镇痛药、抗菌物、抗病毒药物存在较强肝毒性;在儿童DILI治疗中,临床医师宜控制联合用药品种、按说明书用法用量给药,选用适当溶剂及溶剂用量。

关键词: 药物性肝损伤, 临床特点, 合理用药, 儿童

Abstract: Objective To study the clinical features, causal drugs and treatment of drug-induced liver injury(DILI) in children in order to contribute to rational drug application. Methods The clinical data on 70 children with DILI treated in Hunan Children's Hospital between January 2015 and May 2019 was analyzed. Results The ratio of males to females among these 70 cases was 2.04:1. Most of the children were aged 1 month to 1 year. Forty percent of the patients exhibited few apparent symptoms, except a few of them who exhibited fever, fatigue and poor appetite without specificity. Diagnosis suggested that most of these patients suffered from hepatocellular liver injury (28.57%), cholestasis liver injury (28.57%) or mixed liver injury (18.57%). Among these cases, 21 (24.29%) were induced by antipyretic analgesics, 13 (24.29%) by antimicrobials and 12 (17.14%) by antiviral drugs. Bifendate, glutathione and diisopropylamine dichloroacetate were commonly used drugs for DILI patients. Sixty-six of these cases (94.29%) were treated with two or more types of drugs. Moreover, improper drug use was observed, such as wrong usage and dosage of biphenyl diester, wrong solvents of glycyrrhizin and polyene phosphatidylcholine injection, and inappropriate concentrations of potassium and magnesium aspartate. Conclusion Overdose of antipyretic and analgesic drugs, antibacterial drugs and antiviral drugs in patients can result in significant hepatotoxicity. Clinicians should carefully select drugs and treat DILI children with drugs according to the instructions.

Key words: drug-induced liver injury, clinical features, rational drug use, children

中图分类号:

R994.11

李静, 何莉梅, 张海霞, 杨智, 彭翠英. 70例儿童药物性肝损伤用药分析[J]. 中国药物警戒, 2020, 17(7): 431-436.

LI Jing, HE Limei, ZHANG Haixia, YANG Zhi, PENG Cuiying. Analysis of 70 Cases of Children with Drug-induced Liver Injury[J]. Chinese Journal of Pharmacovigilance, 2020, 17(7): 431-436.

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