62例儿童药物性肝损伤的回顾性分析

Retrospective analysis of 62 children with drug-induced liver injury

目的 研究药物性肝损伤(DILI)患儿的临床特征。方法 回顾性分析河南省儿童医院62例DILI患儿的年龄分布、临床症状、致肝损伤的药物种类、治疗药物、临床转归、肝功能指标、Roussel Uclaf因果关系评估分值(RUCAM)积分。结果 临床分型中以肝细胞型最为常见,占87.1%(54/62)。高发年龄段为>1~3岁和>3~6岁,分别为33.9%(21/62)和41.9%(26/62)。DILI患儿的临床症状以食欲下降最为常见,占59.7%(37/62)。致患儿DILI的药物种类主要为抗菌药、解热镇痛药、中药等。肝细胞型患儿ALT(765.26±217.52)U/L,胆汁淤积型患儿ALT(132.24±76.51)U/L,混合型患儿ALT(337.26±103.28)U/L,差异有统计学意义(F=21.357,P=0.000);肝细胞型患儿ALP(130.42±87.61)U/L,胆汁淤积型患儿ALP(315.64±105.62)U/L,混合型患儿ALP(201.36±171.35)U/L,差异有统计学意义(F=6.200,P=0.004);肝细胞型患儿AST(571.36±191.64)U/L,胆汁淤积型患儿AST(269.42±105.57)U/L,混合型患儿AST(197.52±72.68)U/L,差异有统计学意义(F=12.574,P=0.000)。治疗后转归良好,痊愈和好转率为93.5%(58/62)。51.6%(32/62)的患儿肝损伤与药物因果关系为可能性大。肝细胞型RUCAM评分(5.8±1.9)分,胆汁淤积型RUCAM评分(6.1±1.7)分,混合型RUCAM评分(5.2±1.5)分,3组比较,差异无统计学意义(F=0.240,P=0.787)。结论 儿童DILI分型以肝细胞型为主,临床应加强对抗菌药、解热镇痛药和中药的肝毒性监测,以减少药物不良反应对儿童的伤害。

Objective To study the clinical characteristics of drug-induced liver injury(DILI) in children. Methods Data were taken retrospectively from the 62 children with DILI in Henan Children’s Hospital, and different variables including age distribution, clinical symptoms, types of drugs causing liver injury, therapeutic drugs, clinical outcome, liver function indexes and the Roussel uclaf causality assessment method(RUCAM) were defined and analyzed. Results Hepatocellular DILI was the most common type based on the R ratio, accounting for 87.1%(54/62). The most affected children were in the 1-3-year-old(33.9%, 21/62) and 3-6 year-old group(41.9%, 26/62). The most prevalent clinical symptom of DILI was loss of appetite(59.7%, 37/62). The drugs causing DILI in children mainly included antibacterial drugs, antipyretic analgesics and Traditional Chinese medicine. There were significant differences in serum ALT, AST and ALP levels among the three types of DILI patients(F=21.357, 12.574, 6.200, all P<0.05). Outcomes for patients with DILI were excellent after treatment, and the recovery rate was 93.5%(58/62). 51.6%(32/62) of the children with liver injury were “highly likely” to be related to drug causality. RUCAM scale scores of the hepatocellular, cholestatic and mixed types were 5.8±1.9, 6.1±1.7 and 5.2±1.5, respectively. No significant difference among the three groups was found(F=0.240, P=0.787). Conclusion Hepatocellular injury is the main type in children with DILI. Clinical monitoring hepatotoxicity of antibiotics, antipyretic analgesics and Traditional Chinese medicine should be strengthened to reduce the adverse drug reactions to children.