中药导致儿童肝损伤的调查分析

Investigation and analysis of liver injury caused by traditional Chinese medicine in children

目的:分析中药导致肝损伤(HILI)患儿的临床特征。方法:回顾性分析河南省儿童医院53例HILI患儿的类型、年龄分布、临床表现、肝功能指标、免疫指标和肝损伤与药物因果关系(RUCAM)。结果:HILI患儿的多发年龄段为1~3岁(43.4%),临床分型主要为肝细胞型占90.6%,临床症状以食欲不振最为常见占92.5%,其次为黄疸(84.9%)、乏力(64.2%)和恶心呕吐(60.4%)等,各类型患儿肝功能指标差异明显,胆汁瘀积型肝损伤患儿的免疫指标水平明显高于肝细胞型和混合型患儿;RUCAM分析显示,13.2%的HILI患儿与中药关联性“极可能”相关,60.4%的为“很可能”相关。结论:HILI患儿以肝细胞型为主,临床医师需重视中药导致的儿童肝毒性,保证患儿的用药安全。

Objective:To investigate the clinical characteristics of herb-induced liver injury(HILI)in children.Methods:The type,age distribution,clinical manifestation,liver function index,immune index,liver injury and roussel uclaf causality assessment method(RUCAM)score of 53 children with HILI in henan children's hospital were retrospectively analyzed.Results:The age range of the children was 43.4%in 1~3 years old,and the clinical classification was mainly hepatocyte type accounting for 90.6%.The clinical manifestations were anorexia.The most common clinical symptoms were anorexia(92.5%),followed by jaundice(84.9%),fatigue(64.2%)and nausea and vomiting(60.4%).There were significant differences in liver function indexes among different types of children.The level of immune index was higher than that of hepatocyte type and mixed type.RUCAM analysis showed that 13.2%of HILI children had a“very likely”correlation with traditional Chinese medicine,and 60.4%had a"very likely"correlation.Conclusion:Hepatocyte type is the main type of HILI in children.Clinicians should pay attention to the hepatotoxicity caused by TCM to ensure the safety of children's medication.