我国2007-2016年儿童药物性肝损伤文献分析

发布时间：2018-05-06 02:39

本文选题：药物性肝损害 + 儿童　；参考：《中国药房》2017年32期

【摘要】：目的:了解目前我国儿童药物性肝损伤(DILI)的流行病学特点,为减少药品不良反应提供参考。方法:以"肝损伤""肝损害""肝毒性""肝炎""肝病""药物性""儿童"为关键词,检索2007-2016年中国知网、万方数据库的国内相关文献,详细记录文献中DILI患儿的临床资料并进行分析。结果:共检索到文献363篇,最终纳入有效文献13篇,涉及665例患儿。其中,男性424例(63.76%),女性241例(36.24%),男女比例为1.76∶1;患儿年龄最小1月,最大14岁,平均7.87岁,其中7岁以上337例,占50.68%。患儿基础疾病前3位为呼吸道感染40例(31.50%)、血液病29例(22.83%)和肿瘤14例(11.02%)。导致儿童DILI的药物种类前3位为抗菌药物(245例,34.41%)、中药(143例,20.08%)和解热镇痛药(113例,15.87%)。DILI发生时间以用药4周内多见(332例,82.18%);临床分型以肝细胞型为主(382例,65.30%);肝损害严重程度主要为轻中度(505例,86.32%),重症以上的80例(13.68%),其中包括31例(5.30%)肝衰竭。临床症状主要表现为纳差、黄疸、恶心呕吐、乏力和腹部不适;经停药及治疗后,96.54%的患儿明显好转或治愈,死亡4例(0.60%)。结论:在合理用药的前提下,有必要对造成儿童DILI较多的抗菌药物、中药和解热镇痛药进行用药宣教及监护,重视患儿过敏史及评估肝外症状进展,在发生ADR时应及时停药干预以改善预后。
[Abstract]:Objective: to investigate the epidemiological characteristics of drug induced liver injury (DILI) in children in China and to provide reference for reducing adverse drug reactions. Methods: using "liver injury", "liver injury", "liver injury", "liver toxicity", "hepatitis", "liver disease", "drug nature" and "children" as the key words, we searched the relevant literatures in China from 2007 to 2016 in Wanfang database. The clinical data of children with DILI were recorded and analyzed in detail. Results: a total of 363 articles were retrieved, and 13 effective ones were included, involving 665 children. Among them, 424 cases were male and 241 cases were female, the ratio of male to female was 1.76: 1, the age of the child was 1 month, the maximum was 14 years old, the average was 7.87 years old, 337 cases were over 7 years old, accounting for 50.68%. The first 3 cases were respiratory tract infection (n = 40), hematologic diseases (n = 29) and tumor (n = 14). The first three drugs leading to DILI in children were 245 cases of antimicrobial agents (34.41%), 143 cases of Chinese medicine (20.08 cases) and 113 cases of antipyretic analgesics (113 cases). There were 332 cases (82.18%) in the four weeks after treatment; 382 cases were classified as hepatocyte type (n = 382) and 65.30% (n = 65.30). The main degree of liver failure was 86.32 in 505 cases of mild to moderate degree, and 13.68% in 80 cases of more severe cases, including 31 cases of liver failure (5.30%). The main clinical symptoms were anorexia, jaundice, nausea and vomiting, fatigue and abdominal discomfort. Conclusion: under the premise of rational use of drugs, it is necessary to educate and monitor the use of antibiotics, traditional Chinese medicine and antipyretic analgesics, pay attention to the allergic history of children and evaluate the progress of extrahepatic symptoms. In case of ADR, the intervention should be stopped in time to improve the prognosis.
【作者单位】：玉林市妇幼保健院药剂科;玉林市妇幼保健院医务科;
【分类号】：R725.7

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