唑类抗真菌药物致药物性肝损伤50例分析Δ

发布时间：2018-01-13 03:33

本文关键词：唑类抗真菌药物致药物性肝损伤50例分析Δ　出处：《中国药房》2016年11期 　论文类型：期刊论文

【摘要】：目的:了解唑类抗真菌药物致药物性肝损伤的现状,探讨有效的防治措施,为临床安全、合理使用唑类抗真菌药物提供参考。方法:收集1989年1月-2014年12月我国公开发表的医药学期刊中有关唑类抗真菌药物致药物性肝损伤的个案报道,对唑类抗真菌药物致药物性肝损伤患者的年龄、性别、药品名称、用法用量、出现症状时间、转归等情况进行统计、分析。结果:共收集到相关文献36篇共50例个案报道,包括酮康唑致肝损伤29例(58%)、氟康唑致肝损伤9例(18%)、伊曲康唑致肝损伤8例(16%)、伏立康唑致肝损伤4例(8%)。药物性肝损伤患者的肝损伤与患者年龄、性别、用药疗程不相关,治愈率为88%。转归较差的患者6例(12%),其中4例经治疗无效死亡,2例因病情危重放弃治疗。因联合用药致药物性肝损伤的患者2例。结论:患者在服用唑类抗真菌药物时应定期检测肝功能和监测血药浓度,有条件时行基因检测,可降低肝损伤风险。确诊的药物性肝损伤患者应立即停药,及时进行退黄、降酶等保肝治疗或人工肝血浆置换、肝移植等手术治疗。
[Abstract]:Objective: to understand the status quo of drug-induced liver injury caused by azole antifungal drugs, explore effective prevention measures for clinical safety, rational use of azole antifungal drugs to provide reference. Methods: the case reports collected in January 1989 -2014 year in December Chinese medical journals related to azole antifungal drug induced liver injury the drug, to azole antifungal drugs to patients with drug-induced liver injury of age, sex, drug name, dosage, time of symptoms, statistical analysis, outcome of the situation. Results: a total of 36 reports collected a total of 50 cases, including 29 cases of liver injury caused by ketoconazole (58%). 9 cases of liver injury induced by fluconazole (18%), 8 cases of liver injury induced by itraconazole (16%), 4 cases of liver injury induced by voriconazole (8%). Liver injury and the age of patients, patients with drug-induced liver injury not related to gender, course of treatment, the cure rate was 88%. poor prognosis 6 patients (12%), of which 4 cases died after treatment, 2 cases with critical condition to give up treatment. Due to drug-induced liver injury caused by combined medication in 2 cases. Conclusion: Patients with liver function and blood concentration monitoring regularly detected in use of azole antifungal drugs, detection of the conditions by gene. To reduce the risk of liver damage in patients with drug induced liver injury diagnosis should be discontinued immediately in a timely manner, jaundice, liver and reducing enzyme treatment or artificial liver plasmapheresis, liver transplantation surgery.

【作者单位】：无锡市第二人民医院/南京医科大学附属无锡第二医院药剂科;
【基金】：无锡市医院管理中心2013年度医学科研药学项目(No.YGZXY1301)
【分类号】：R575
【正文快照】： 20世纪80年代以来,广谱抗生素大量使用,人类免疫缺陷病毒(HIV)感染以及癌症化学治疗和器官移植等因素导致真菌感染率逐年上升[1],由此引发了抗真菌药物的大量使用;而抗真菌药物的肝毒性也为抗真菌感染的治疗带来了困难,其风险效益比有待重新衡量。目前,唑类抗真菌药物对深部真

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