中草药相关肝损伤文献分析及药物性肝损伤回顾性病例系列研究

发布时间：2018-03-15 18:21

本文选题：药物性肝损伤　切入点：临床调查　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的随着现代疾病谱的变化和新药的广泛临床应用,临床药物性肝损伤病例呈逐年上升态势。与国外以抗生素、消炎镇痛类药物、抗结核药物等西药为主引起药物性肝损伤(Drug-induced Liver Injury,DILI)不同的是,国内中草药、保健品、膳食添加剂引起肝损伤病例占比高,药物致肝衰竭等严重病例时有发生。对DILI的诊断和治疗特别是中草药相关肝损伤(herb-induced liver injury,HILI)容易被患者本人甚至临床医生忽视或误诊。本研究的目的是通过对HILI临床病例文献进行汇总分析和对“真实世界”因DILI住院患者的验证性临床回顾性病例系列研究,对DILI的影响因素、临床表现及分型、药物治疗前后临床指标变化等汇总分析,为临床用药提供参考。对象和方法(1)文献分析:通过计算机检索MEDLINE、Pubmed、中国知网等数据库和手工查阅的方式查找2000年1月1日至2016年12月31日国内外公开发表的关于HILI文献,对HILI临床表现、基础疾病及药源性损害等情况进行研究;(2)回顾性病例系列研究:对安徽医科大学第一附属医院自2013年9月1日至2016年8月31日共3年期间DILI住院病例进行回顾性调查分析。对患者的病程、可疑药物、治疗方案、预后等进行总结分析。结果(1)文献分析共纳入HILI相关文献16篇,1696例病例,男女比例=1:1.81,平均年龄(46.12±5.62)岁,从用药到发病平均天数31.5天,住院治疗周期平均21.1天,治疗有效率90.54%,临床分型以肝细胞损伤型为主,主要症状有黄疸(32.7%)、胃肠道反应(25.2%)、乏力(23.5%)和纳差(13.6%),患者基础疾病前三位分别是皮肤疾病、心血管疾病、骨关节疾病,在可辨认成份的引发肝损伤中草药中排名前三位的分别是何首乌、补骨脂、延胡索。(2)3年住院病例的回顾调查共收集到315份病例,患者平均年龄(48.74±15.30)岁,男女比例=1:1.30,引起药物以中药为主(173例,含中草药、中成药),第一次用药到发病平均周期为(25.72±22.14)天,41~70岁为该病的高发期,40岁以上病例占比73%,以肝细胞损伤型病例为主,临床治疗以保肝降酶退黄为主,99.05%病例预后均较好。结论文献分析及临床回顾性病例系列研究表明,农村人群和受教育水平较低人群、中老年和女性人群更易罹患DILI,男女因疾病谱等原因用药有特殊性,多数患者有两种以上药物用药史,中西药物合用现象突出,从用药到发病潜伏期较长,应用相关药物应注意检测肝功能指标。肝损伤类型以肝细胞损伤型为主,国内HILI占比高。保肝降酶治疗一般预后较好。中药较西药引起的DILI的ALT、AST、Hb等肝功能指标更高,肝损伤更严重。
[Abstract]:Objective with the change of modern disease spectrum and the wide clinical application of new drugs, the clinical cases of liver injury caused by drugs are increasing year by year. Drug-induced Liver injury (Drug-induced Liver injury induced by Drug-induced Liver injury) is different from traditional Chinese herbal medicine, health products and dietary additives, and the proportion of cases of liver injury caused by Chinese herbal medicine, health products and dietary additives is high. The diagnosis and treatment of DILI, especially herb-induced liver injuryHILI, are easy to be ignored or misdiagnosed by the patients themselves or even the clinicians. The purpose of this study is to study the diagnosis and treatment of DILI through the clinical practice of HILI. Case literature analysis and validation clinical retrospective case series study of "real world" inpatients with DILI, The influencing factors, clinical manifestations and types of DILI, the changes of clinical indexes before and after drug treatment, etc. To provide references for clinical use of drugs. Objects and methods 1) Literature analysis: the HILI literature published at home and abroad from January 1st 2000 to December 31st 2016 was searched by means of computer retrieval of MEDLINE online, Chinese knowledge Network and other databases, and manual reference was used to find out the literature published at home and abroad from January 1st 2000 to December 31st 2016. For the clinical manifestations of HILI, A retrospective study on basic Diseases and Drug-induced damage: retrospective study on the hospitalized cases of DILI in the first affiliated Hospital of Anhui Medical University during the three-year period from September 1st 2013 to August 2016. Investigation and analysis. The course of disease of the patient, Results A total of 16 cases of HILI were included in the literature analysis. The ratio of male to female was 1: 1.81, with an average age of 46.12 卤5.62 years, and the average days from medication to onset were 31.5 days. The average hospitalization period was 21.1 days, and the effective rate was 90.54. The main clinical types were hepatocyte injury. The main symptoms were jaundice, stomach reaction, stomach and intestine reaction, stomach and intestine reaction, and anorexia. The first three basic diseases were skin disease and cardiovascular disease, respectively. Bone and joint diseases, the top three Chinese herbal medicines for identifying liver injury were Polygonum multiflorum, Psoralen multiflorum, Corydalis corydalis. 2) A total of 315 cases were collected in 3 years. The average age of the patients was 48.74 卤15.30 years old, and the average age of the patients was 48.74 卤15.30 years old, and the average age of the patients was 48.74 卤15.30 years. The ratio of male to female was 1: 1.30. 173 cases were caused by traditional Chinese medicine, including Chinese herbal medicine and Chinese patent medicine. The average period from the first medication to the onset of the disease was 25.72 卤22.14 days. The proportion of cases over 40 years of age in the high incidence period of the disease was 73.The main type was hepatocyte injury. The prognosis of 99.05% cases was good. Conclusion the literature analysis and clinical retrospective case series studies show that the rural population and the population with lower education level have better prognosis. The middle-aged and elderly people and the female population are more likely to suffer from DILI. Because of disease spectrum and other reasons, most patients have more than two kinds of drug use history. The phenomenon of combination of Chinese and western drugs is prominent, from medication to onset incubation period is longer. We should pay attention to the detection of liver function indexes in the application of related drugs. The main type of liver injury is hepatocyte injury type, the proportion of HILI is high in our country. The liver protective enzyme therapy is generally good in prognosis. The liver function index of Chinese medicine is higher than that of DILI caused by western medicine, such as alt, ASTH, HB and so on. Liver injury is more severe.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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