药物性肝损害患者的循证治疗

Evidence-Based Treatment for A Patient with Drug-Induced Liver Injury

目的为1例抗结核治疗所致肝损害患者制定循证治疗方案。方法根据患者的具体情况,提出所需解决的临床问题,全面检索Cochrane图书馆(1970—2011年)、PubMed(1970—2011年)、Embase(1970—2011年)及中国生物医学文献数据库(1990—2011年),获得与药物性肝损害相关的治疗证据。根据已有的证据结合患者的意愿及医师的临床经验制定合理的治疗方案。结果共检索并纳入与药物性肝损害相关的文献17篇。结合患者的情况对检索结果进行综合分析,制定合理的治疗方案:立即停用抗结核药物+还原型谷胱甘肽静脉注射+口服甘草酸二铵。经过6个月的随访,该方案适合患者。结论应用循证医学的方法,采用高质量的证据为患者制定个性化合理的治疗方案,可以提高患者治疗效果,改善患者预后。

Objective To draw up an evidence-based treatment for a patient with drug-induced liver injury.Methods Clinical problems were presented on the basis of the patient′s conditions,and evidence was collected from the Cochrane library（1970 to 2011）,PubMed（1970 to 2011）,Embase（1970 to 2011） and SinoMed database（1990 to 2011）.Reasonable treatment was drawn up on the basis of collected evidence,patient′s willingness and the doctor′s experience.Results A total of 17 documents were retrieved and involved into the study.The results were analyzed and a treatment plan was formulated,which was stopping using anti-tuberculosis drugs combined with glutathione and diammonium glycyrrhizinate.After a six-month follow up,the plan proved to be optimal.Conclusion Through evidence-based method,individual treatment plan based on solid evidence can obviously improve the efficacy and prognosis of the treatment.