药物性肝损伤个例报道的文献分析

Literature Analysis of Case Reports on Drug-induced Liver Injury

目的:探讨药物性肝损伤(DILI)的一般规律和特点,为临床安全用药提供参考。方法:检索中国知网、万方数据库、维普中文数据库DILI的个案报道,对收集到的376篇文献进行筛选、统计分析,包括患者的性别、年龄、基础疾病、用药时间、用药品种,临床表现、临床分型、治疗及转归等。结果:共收集到DILI个例报道99例,可疑药物以中药类最多(44例,44.4%)。58.6%的DILI发生在用药1个月内。79.8%的患者出现各种临床表现,主要有皮肤巩膜黄染(52.5%)、尿黄(45.5%)、乏力(45.5%)、纳差(42.4%)等。对病例进行临床分型,肝细胞损伤型占73.7%,胆汁淤积型占15.2%,混合型占11.1%,各分型中,肝细胞损伤型男女比例为1∶1.92,胆汁淤积型男女比例为1.14∶1,混合型男女比例为1.75∶1。结论:临床应重视DILI;对易发生药物性肝损伤的药物及人群如女性、高龄、饮酒者、合并基础疾病者等应加强用药监护,出现症状时及时处理;加强对患者的用药教育,增强患者的安全用药意识。

Objective: To investigate the general rules and characteristics of drug-induced liver injury(DILI) and provide reference for clinical safe drug use.Methods: Case reports on DILI in China Knowledge Network,Wanfang Database,and VIP Chinese database were searched,and 376 articles were collected for statistical analysis including such items as gender,age,underlying diseases,medication time,drug varieties,clinical manifestations,clinical classification,treatment and outcome.Results: A total of 99 cases of DILI were collected,and among them,44 cases were suspected by traditional Chinese medicine,which accounted for 44.4%.Totally58.6% of DILI occurred within one month after drug use.Totally 79.8% of DILI were with obvious clinical manifestations,including skin sclera yellowing(52.5%),dark urine(45.5%),atigue(45.5%) and poor appetite(42.4%).The clinical types of the above cases included hepatocellular-injury-type DILI(73.7%),cholestasis-type DILI(15.2%) and mixed type DILI(11.1%) with male-tofemale ratio of 1 ∶ 1.92,1.14 ∶ 1 and 1.75 ∶ 1,respectively.Conclusion: Attentions should be paid for DILI.The population prone to DILI includes women,elderly patients,drinkers and patients with underlying diseases,therefore,drug monitoring should be strengthened,and symptomatic treatment should be performed timely.Meanwhile,medication education for patients should be strengthened to enhance awareness of safe medication.