儿童药物性肝损伤的病因及临床特点分析

摘要/Abstract

摘要： 目的了解药物性肝损伤患儿的致病原因及其临床特点。方法对2008年1月至2019年6月平煤神马医疗集团总医院病历管理系统进行检索,发现年龄小于14岁患有药物性肝损伤患者共41例,疾病诊断要求符合2004年版药物性肝损伤标准。药物性肝损伤的临床分型采纳的是Danan方案。结果 41例患儿中,男24例,女17例,平均年龄(8.3±3.5)岁,最小为5月龄,最大14岁,其中1岁以下3例,1至3岁4例,4至9岁16例,10至14岁18例。ALT为925(458,1655)U/L,AST为525(175,1284)U/L,碱性磷酸酶325(248,486)U/L,总胆汁酸108(28,198)μmol/L。共有14例患儿行肝活组织检查,符合药物性肝损伤临床分型中肝细胞型9例,胆汁淤积型2例,混合型3例。引起肝损伤的药物包括16例应用抗菌类药物,其中9例应用大环类酯类, 4例应用青霉素类, 3例应用头孢菌素类; 13例应用中成药或中药制剂; 6例应用化疗或免疫抑制药物; 2例应用抗结核药物;其他还包括4例应用解热镇痛药、精神类药物。临床特点包括乏力23例,食欲下降31例,恶心16例,皮肤黄染或尿液色黄11例,呕吐7例,皮肤瘙痒或皮疹6例。结论儿童药物性肝损伤在各年龄层均可出现,主要药物为抗菌药物、中药、化疗或免疫抑制药物等,在儿童用药过程中应对这些药物重点防控、酌情使用。

关键词: 药物性肝损伤, 儿童, 抗菌类药物, 临床特点

Abstract: Objective To analyze the causes and clinical characteristics of the children with drug-induced liver injury (DILI) in our hospital. Methods A total of 41 patients with DILI under 14 years in our hospital from January 2008 to June 2019 were included, by searching the medical records management system. The diagnosis was established according to DILI standard proposed in 2004. Danan regimen was adopted in the clinical classification of DILI. The measurement data of normal distribution are presented as mean ± standard deviation, the measurement data of non-normal distribution are presented as median (percentage 25, percentage 75), and the count data are presented as percentage. Results Among the patients included, 24 were male (58.5%) and 17 were female (41.5%). The average age was (8.3 ± 3.5) years, ranging from 5 months to 14 years. Among them, 3 were under 1 year (7.3%), 4 were 1 to 3 years old (9.8%), 16 were 4 to 9 years old (39.0%), and 18 were 10 to 14 years old (43.9%). The alanine aminotransferase was 925 (458, 1655) U/L, the aspartate aminotransferase was 525 (175, 1284) U/L, the alkaline phosphatase was 325 (248, 486) U/L, and the total bile acid was 108 (28, 198) mol/L. A total of 14 patients underwent liver biopsy, among whom 9 cases (64.3%) were diagnosed as hepatocellular injury, 2 cases (14.3%) as cholestatic injury and 3 cases (21.4%) as mixed type. The drugs causing DILI included antibacterial drugs (16, 39.0%), Chinese patent medicines or Chinese medicine preparations (13, 31.7%), chemotherapeutic or immunosuppressive drugs (6, 14.6%), anti-tuberculosis drugs (2, 4.9%), antipyretic analgesics and psychotropic drugs (4, 9.8%). Furthermore, antibacterial drugs included macrolides (9, 22.0%), penicillins (4, 9.7%) and cephalosporins (3, 7.3%). And clinical symptoms of these DILI patients included fatigue (23, 56.1%), loss of appetite (31, 75.6%), nausea (16, 39.0%), icteric skin or dark urine (11, 26.8%), vomiting (7, 17.1%), and pruritus or rash (6, 14.6%). Conclusion DILI in children can occur in different ages, and the main drugs leading to the disease are antibiotics, traditional Chinese medicine, chemotherapeutic and immunosuppressive drugs. In the future, these drugs should be appropriately used in children with caution.

Key words: Drug-induced liver injury, Children, Antibacterial agents, Clinical characteristics

田春丽, 梁科峰, 赵玉. 儿童药物性肝损伤的病因及临床特点分析[J]. 肝脏, 2020, 25(1): 31-33.

TIAN Chun-li, LIANG Ke-feng, ZHAO Yu. Analysis of etiology and clinical characteristics of drug-induced liver injury in children[J]. Chinese Hepatolgy, 2020, 25(1): 31-33.

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