中药致药物性肝损伤的临床特点和危险因素：一项系统评价研究

发布时间：2019-06-04 08:54

【摘要】：目的:系统评价中药致药物性肝损伤(traditional Chinese medicine-induced liver injury,TCM-ILI)的临床特点、危险因素、预后以及在总体药物性肝损伤(drug-induced liver injury,DILI)患者中所占的比率。材料与方法:检索相关期刊论文、万方数字化期刊全文数据库、中国科技期刊数据库、Pub Med和Embase数据库。检索有关TCM-ILI的文献。使用Med Calc 15.2.2和Stats Direct 2.7.8软件对纳入文献进行统计、系统评价,使用Q检验和I2检验判断各研究间异质性。使用随机效应模型对数据合并分析。根据内容将纳入的文献分为三类:1)可统计患者化验结果的病例报道研究;2)TCM-ILI的病例系列研究;3)总体DILI的病例系列研究,并报道了TCM-ILI占总体DILI的比率。结果:共检索出文献21027篇,纳入624篇。病例报道178篇,涉及321例患者。TCM-ILI患者中,女性占63.10%;平均年龄为46岁;平均服药时间为78.72天。黄疸(72.25%)、纳差(44.49%)和恶心(37.00%)为主要症状。何首乌为常见的导致TCM-ILI的药物(15.26%)。4.67%的患者死亡。男性、低白蛋白、高谷草转氨酶和高直接胆红素与预后不良相关。病例系列25篇,涉及1631例患者。女性占64.49%;乏力占64.69%;因妇科病使用中药占54.01%。421篇文献可提取TCM-ILI占总体DILI的比率,涉及DILI患者50988例,其中TCM-ILI患者13438例,TCM-ILI比率为25.71%。中国文献418篇,TCM-ILI比率为25.74%。福建省TCM-ILI比率最低(18.48%);重庆市最高(33.66%)。以老年人为研究人群的TCM-ILI比率为20.43%;以肝衰竭患者为研究人群的TCM-ILI比率为31.95%。结论:TCM-ILI常见于女性;常见症状为黄疸、纳差和恶心。男性、低白蛋白、高谷草转氨酶和高直接胆红素提示预后不佳。在我国DILI患者中,有1/4因TCM-ILI住院。
[Abstract]:Objective: to systematically evaluate the clinical characteristics, risk factors and prognosis of drug-induced liver injury (traditional Chinese medicine-induced liver injury,TCM-ILI) induced by traditional Chinese medicine (TCM) and its proportion in patients with drug-induced liver injury (drug-induced liver injury,DILI). Materials and methods: Chinese periodical full-text database, Wanfang digital periodical full-text database, Chinese sci-tech periodical database, Pub Med and Embase database were searched. Search the literature about TCM-ILI. Med Calc 15.2.2 and Stats Direct 2.7.8 software were used to make statistics and systematic evaluation of the included literature. Q test and I2 test were used to judge the heterogeneity among the studies. The random effect model is used to merge and analyze the data. According to the content, the literature will be divided into three categories: 1) the case report study of statistical patient test results; 2) the case series study of TCM-ILI; 3) the case series study of total DILI, and reports the ratio of TCM-ILI to total DILI. Results: a total of 21027 literatures were searched and included in 624. 178 cases were reported, involving 321 patients. 63.10% of TCM-ILI patients were female, the average age was 46 years old, and the average medication time was 78.72 days. Jaundice (72.25%), anorexia (44.49%) and nausea (37.00%) were the main symptoms. Polygonum multiflori was a common drug causing TCM-ILI (15.26%). 4.67% of the patients died. Male, low albumin, high glutamic oxaloacetic transaminase and high direct bilirubin are associated with poor prognosis. There are 25 cases in a series of 1631 patients. Female accounted for 64.49%, fatigue accounted for 64.69%, traditional Chinese medicine was used in 54.01% because of gynecological diseases. 421 articles were able to extract TCM-ILI in the total DILI, involving 50988 patients with DILI, including 13438 patients with TCM-ILI and 25.71% with TCM-ILI. The TCM-ILI ratio was 25.74% in 418 Chinese literatures. Fujian Province had the lowest TCM-ILI ratio (18.48%) and Chongqing had the highest TCM-ILI ratio (33.66%). The TCM-ILI rate was 20.43% in the elderly and 31.95% in the patients with liver failure. Conclusion: TCM-ILI is common in women, and the common symptoms are jaundice, anorexia and nausea. Male, low albumin, high glutamic oxaloacetic transaminase and high direct bilirubin suggest poor prognosis. In China, 1 / 4 of DILI patients were hospitalized with TCM-ILI.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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