29例儿童药物性肝损伤临床分析

Analysis of 29 Cases with Drug-Induced Liver Injury in Children

目的:研究药物性肝损伤临床特点及病因,为临床防治提供资料。方法:回顾性分析我院儿童药物性肝损伤患儿服药史、临床表现、服药基础疾病、治疗及转归等。结果:29例患儿中,男21例,女8例,以纳差、恶心呕吐、尿黄、乏力等为主要临床表现,有48.27%患儿仅以肝功能异常就诊。分型以肝细胞损伤型为主20例,混合型5例,胆汁淤积型4例;肝细胞损伤组ALT值最高,胆汁淤积组AST和TB值最高。导致肝损伤的药物类别主要有抗感染药(38.77%)、抗肿瘤药(28.57%)、中药(10.2%)、激素(8.16%)等;服药基础疾病为肿瘤11例、感染性疾病10例、发热3例、腹泻2例、感冒2例、抽动症1例。经治疗19例治愈,8例好转,1例进行肝移植,1例自动出院。结论:儿童药物性肝损伤仅肝功能指标异常者比例较大,需警惕误诊漏诊;引起儿童肝损伤药物以抗肿瘤药和抗感染药为主,其中布洛芬引起后果较严重,需关注其安全性;患者多数转归较好。

Objective： To study the clinical characteristics and risk etiological factors of drug-induced liver injury （DILI） cases, and provide information for clinical prevention and treatment. Methods： Retrospective analysis medication history, clinical manifestations, underlying diseases, treatment and prognosis of children with DILI in our hospital. Results： Twenty-one cases were male, 8 female. Main clinical manifestations include anorexia, nausea and vomiting, yellow urine, weak, 48.27% children only with abnormal liver function. Classification mainly based on liver injury in 20 cases, mixed in 5 cases, 4 cases of cholestasis. ALT was the highest in liver cell injury group, AST and TB was the highest in cholestasis group. Suspected drugs include anti-infective drugs （38.77%）, anti tumor drugs （28.57%）, traditional Chinese medicine （10.2%） and hormones （8. 16% ）. The underlying diseases were 11 cases of tumor, 10 cases of infectious diseases, 3 cases of fever, 2 cases of diarrhea, 2 cases of cold, 19 cases cure, better 53 cases and 1 case of liver transplantation, 1 case discharged. Conclusion： The children with DILI only showed abnormal with liver function index, attention should be paid to the missed diagnosis and misdiagnosis. Drug induced liver injury in children with anti-tumor drugs and anti-infection drugs, which ibuprofen cause serious consequences, should pay attention to the safety. Most of the children had good outcomes.