83例药物性肝损伤回顾性分析及保肝药的应用分析

摘要/Abstract

摘要： 目的：研究药物性肝损伤的诱发药物、临床特点，分析保肝药应用的合理性，为临床药师进一步指导临床用药提供依据。方法：回顾性分析我院2018—2021年诊断为药物性肝损伤患者的临床特征及保肝药的应用。结果：共纳入83例患者，其中男性39例（46.98%），女性44例（50.57%）， 18～44岁病例较多，共32例（38.55%）； 43例（51.81%）无明显临床症状，其余患者临床症状与一般肝损伤无差异。引起药物性肝损伤排名前三位的药物为中药（24例，28.92%），抗肿瘤药（12例，14.46%），抗感染药物（10例，12.05%）；药物性肝损伤最常见的分型为肝细胞损伤型（38例，81.92%）；40例患者的Roussel Uclaf因果关系评估法（RUCAM）评分结果为可能（48.19%）；严重程度分级1级68例（81.93%）；治疗后74例（89.16%）好转。81例患者（97.59%）应用保肝药，9例患者预防性应用保肝药，其余患者为治疗性应用，26例患者联合应用3种及以上保肝药。应用的药物以多烯磷脂酰胆碱注射液、注射用还原谷胱甘肽、甘草酸制剂为主，极少数患者应用糖皮质激素。结论：引起药物性肝损伤种类较多，临床表现缺乏特异性。用药期间应监测肝功能，尽早发现并及时干预。临床药师应熟悉药物性肝损伤的临床特征和防治措施，掌握药物治疗的方案，在DRGs 改革的背景下提供专业的用药指导。
[关键词]

关键词: font-size:medium, ">药物性肝损伤；RUCUM评分；保肝药；合理用药；DRGs

Abstract: Objective：To explore the inducing drugs and clinical characteristics of drug-induced liver injury， analyze the rationality of the application of liver protection drugs， and provide references for clinical pharmacists to guide clinical medication. Methods：The clinical features of patients diagnosed with drug-induced liver injury in our hospital from 2018 to 2021 and the application of hepatoprotective drugs were retrospectively analyzed. Results：A total of 83 cases of drug-induced liver injury were included， among which 39 cases(46.98%) were male and 44 cases(50.57%) were female. 32 cases(38.55%) were 18 to 44 years old. 43 cases(51.81%) had no obvious clinical symptoms， and the clinical symptoms of the rest patients were not different from the general liver injury. The top three drugs causing drug-induced liver injury were traditional Chinese medicine(24 cases， 28.92%)， antineoplastic drugs(12 cases，14.46%) and anti-infective drugs(10 cases，12.05%). The most common type of drug-induced liver injury was hepatocyte injury(38 cases，81.92%). The RUCAM score of 40 cases(48.19%) were “probable”.68 cases(81.93%) were grade 1 hepatic injury. 74 cases(89.16%) improved after treatment.81 patients(97.59%) received hepatoprotective drugs， 9 patients received prophylactic therapy， and the rest received therapeutic drugs. 26 patients were treated with three or more hepatoprotective drugs. The main drugs used were polyene phosphatidylcholine injection， reduced glutathione for injection，glycyrrhizic acid preparation， and glucocorticoid was used in very few patients. Conclusion：There are many kinds of drug-induced liver injury and the clinical manifestation lack of specificity. Liver function should be monitored during treatment， with early detection and timely intervention. Clinical pharmacists should be familiar with the the clinical characteristics and prevention and treatment measures of drug-induced liver injury， and provide professional medication guidance under the background of DRGs reform.

Key words: font-size:medium, ">Drug-induced liver injury； RUCAM score； Hepatoprotective drugs； Rational medicine； DRGs

中图分类号:

田娜妮, 何青青, 朱琳, 姚杨, 惠娇娇, 梁乐, 白婷, 杨蕊, 李霄. 83例药物性肝损伤回顾性分析及保肝药的应用分析[J]. 中国医药导刊, 2023, 25(2): 205-209.

TIAN Nani, HE Qingqing, ZHU Lin, YAO Yang, HUI Jiaojiao, LIANG Le, BAI Ting, YANG Rui, LI Xiao. Retrospective Analysis of 83 Cases of Drug-Induced Liver Injury and Application of Hepatoprotective Drugs[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2023, 25(2): 205-209.

参考文献

[1]中华医学会，中华医学会杂志社，中华医学会消化病学分会等.药物性肝损伤基层诊疗指南(2019年)[J].中华全科医师杂志，2020，19(10)：868-875.
     [2]Shen T， Liu Y， Shang J， et al. Incidence and etiology of drug-induced liver injury in mainland China[J]. Gastroenterology， 2019，156(8)：2230-2241.
     [3]茅益民，曾民德，陈勇，等.异甘草酸镁治疗ALT升高的慢性肝病的多中心、随机、双盲、多剂量、阳性药物平行对照临床研究[J].中华肝脏病杂志，2009(11)：847-851.
     [4]Danan G， Teschke R. RUCAM in drug and herb induced liver injury： The update[J]. Int J Mol Sci，2015， 24，17(1)：14.
     [5]杨焕芝，闫鸿丽，陈国兵，等.药物性肝损伤住院患者临床特点回顾性分析[J].医药导报，2021，40(5)：678-682.
     [6]Bj?rnsson ES， Bergmann OM， Bj?rnsson HK， et al. Incidence， presentation， and outcomes in patients with drug-induced liver injury in the general population of Iceland[J]. Gastroenterology， 2013，144(7)：1419-1425.
     [7]Lucena MI， Andrade RJ， Kaplowitz N， et al. Phenotypic characterization of idiosyncraticdrug-induced liver injury： the influence of age and sex[J]. Hepatology， 2009，49：2001-2009.
     [8]deLemos A， Foureau D， Jacobs C， et al.Drug-induced liver injury with autoimmune features[J]. Semin Liver Dis， 2014，34：194-204.
     [9]Boelsterli UA， Lee KK. Mechanisms of isoniazid-induced idiosyncratic liver injury： Emerging role of mitochondrial stress[J]. J Gastroenterol Hepatol， 2014，29(4)：678-687.
     [10]Felker D， Lynn A， Wang S，et al. Evidence for a potential protective effect of carnitine-pantothenic acid co-treatment on valproic acid-induced hepatotoxicity[J]. Expert Rev Clin Pharmacol， 2014，7：211-218.
     [11]张艳梅，孙文静，文良志，等.近5年我国药物性肝损伤患者临床特征分析[J].临床肝胆病杂志，2018，34(3)：562-566.
     [12]倪建腾，马致洁，定瑶，等.何首乌饮片及其制剂所致肝损伤不良反应的文献分析[J].中国医院用药评价与分析，2022，22(4)：483-486.
     [13]Devarbhavi H， Aithal G， Treeprasertsuk S， et al. Drug-induced liver injury： Asia pacific association of study of liver consensus guidelines[J]. Hepatol Int， 2021，15(2)：258-282.
     [14]张林祥，沈明，邱刚，等.基层医疗机构216例药物性肝损伤不良反应分析与对策[J].中国药物应用与监测，2018，15(1)：32-35.
     [15]于乐成，茅益民，陈成伟.药物性肝损伤诊治指南[J].临床肝胆病杂志，2015，31(11)：1752-1769.
     [16]Devarbhavi H， Aithal G， Treeprasertsuk S， et al. Asia pacific association of study of liver. drug-induced liver injury： Asia pacific association of study of liver consensus guidelines[J]. Hepatol Int，2021，15(2)：258-282.
     [17]中华医学会结核病学分会，唐神结，顾瑾，等.抗结核药物性肝损伤诊治指南(2019年版)[J].中华结核和呼吸杂志，2019(5)：343-356.
     [18]Karkhanis J， Verna EC， Chang MS， et al. Steroid use in acute liver failure[J]. Hepatology， 2014，59：612-621.
     [19]潘晨，沈素.15336例药物性肝损伤的临床特点分析[J].临床药物治疗杂志，2018，16(9)：43-47
     [20]Aiso M，Takikawa H，Tsuji K，et al.Analysis of 307 cases with drug-induced liver injury between 2010 and 2018 in Japan[J].Hepatol Res，2019，49(1)： 105-110.

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