关键词: 药物性肝损伤, 儿童, Logistic回归分析

Abstract: Objective To explore the etiology,clinical features and prognostic factors of drug-induced liver injury (DILI) in children,and to improve the understanding of DILI in children.Methods From January 2007 to December 2019,128 children (76 males and 52 females) with DILI (<14 years old) were admitted to our hospital.Measurement data were expressed in (±s),t-test was used,counting data was expressed in (%),and chi-square test was used.Results The primary diseases include respiratory tract infection,malignant tumor,drug allergy and local inflammatory diseases.The types of drugs include western medicine and traditional Chinese medicine/proprietary Chinese medicine.Seventy cases (54.7%) of western medicine,including antimicrobials (macrocyclic esters,penicillin,cephalosporins),anti-tuberculosis drugs (isoniazid,rifampicin),antineoplastic drugs (cytarabine,methotrexate,azathioprine),and hormone drugs.Twenty-six cases (20.3%) of traditional Chinese medicine/proprietary Chinese medicine,including traditional Chinese medicine/proprietary Chinese medicine preparation and herbal medicine.Thirty-two cases (25.0%) were used in combination.The youngest patient was 5 months old,the oldest was 14 years old,8 cases were under 1 year old (6.3%),11 cases were 1 to 3 years old (8.6%),68 cases were 4 to 9 years old (53.1%),and 41 cases were 10 to 14 years old (32.0%).According to the clinical classification of DILI,there were 90 cases of hepatocyte type (70.3%),24 cases of cholestasis type (18.7%) and 24 cases of mixed type (18.7%).DILI severity grade was mild in 56 cases (43.7%),moderate in 65 cases (50.8%) and severe in 7 cases (5.5%).The pathological findings of transhepatic puncture (78 cases,60.9%) included inflammatory cell infiltration (such as neutrophils,eosinophils),hepatocyte steatosis,hepatocyte punctate necrosis and/or interface hepatitis.The clinical manifestations of children with DILI were fatigue in 72 cases (56.3%),loss of appetite in 69 cases (53.9%),nausea and vomiting in 25 cases (19.5%),yellow skin or yellow urine in 38 cases (29.7%),and skin pruritus or rash in 16 cases (12.5%).After stopping medication and symptomatic treatment,24 children with DILI were cured (18.8%),90 cases improved (70.3%),14 cases were not cured (10.9%),and there was no death.The cured and improved cases were defined as effective group (n=114),and the uncured cases were defined as ineffective group (n=14).There were significant differences in age,ALT,international standardized ratio (INR) and drug types between the two groups (P<0.05).Conclusion Most of the children with DILI were relieved after stopping treatment,and the prognosis of the children with DILI who were younger and took traditional Chinese medicine/proprietary Chinese medicine was worse than that of the older children who took western medicine.In the process of drug use for children in the future,we should focus on prevention and control of drug use and use it as appropriate,so as to reduce the incidence of DILI.

Key words: Drug-induced liver injury, Children, Logistic regression analysis