药物性肝炎临床特征及相关危险因素分析
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- 英文论文题名：Clinical characteristics of drug-induced liver injury and related factors
- 论文作者：陆人杰 ; 朱珊梅 ; 唐风雷 ; 范正达 ; 郑中伟
- 英文论文作者：LU Ren-jie ; ZHU Shan-mei ; TANG Feng-lei ; Fan Zheng-da ; ZHENG Zhong-wei ; Department of Pharmacy ; Third People's Hospital ; Department of Gastroenterology ; Third People's Hospital
- 年：2016
- 作者机构：常州市第三人民医院药事科;常州市第三人民医院消化内科;
- 论文关键词：药物性肝炎 ; 临床特点 ; 危险因素
- 英文论文关键词：Drug-induced liver injury ; Clinical characteristics ; Risk factors
- 会议召开时间：2016-09-27
- 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
- 语种：中文
- 分类号：R575.1
- 学会代码：YYWS
- 会议名称：中国药学会第十三届青年药学科研成果交流会
- 会议地点：中国江西南昌
- 主办单位：中国药学会
- 学会名称：中国药学会
- 页数：5
- 文件大小：395k
- 原文格式：O
- 会议级别：全国
摘要
目的:评价药物性肝炎(drug-induced liver injury,DILI)的临床特征,总结其发病规律、临床特点、肝损药物种类及危险因素。方法:收集第一临床诊断为DILI收治住院患者作系统性回顾调查,根据住院患者的临床症状、实验室指标、基础疾病、肝损药物等信息,对比研究西药与中药所致药物性肝损伤的分布情况,分析不同临床分型的患者临床资料的差异性,探讨可能与DILI相关的危险因素。结果:患者临床症状发生频率≥50%依次为乏力、纳差、尿黄。胆汁淤积型患者碱性磷酸酶值及凝血酶原活动度值最高(P<0.05)。中药引起的DILI患者比例高达60.6%,引起的DILI较为常见的西药有抗结核药、精神类药、非甾体抗炎药等。DILI相关因素肝胆疾病、免疫功能失调、糖尿病、高血压、长期饮酒、年龄≥45岁的0R值分别为6.552、6.1 30、3.774、2.801、2.002、1.838。结论:凡是服用可疑导致肝损药物过程中或过程后出现乏力、恶心呕吐、食欲不振、纳差、肝区不适等表现或肝功能异常者均应得到高度警惕。原患肝胆疾病、糖尿病、高血压、高龄、长期饮酒、免疫功能失调很可能使服药者对药物的易感性增高,更容易引起肝脏损害,临床上对有这些危险因素的肝功能异常患者应优先考虑可能DILI。
Objective To comprehensively assess the clinical characteristics,laboratory indices,hepatotoxic drugs and risk factors concerning drug-induced liver injury(DILI).Methods:Data of patients who were hospitalized with a first diagnosis of DILI were collected for systematic retrospective study.Based on the clinical symptoms,laboratory indices,underlying diseases,hepatotoxic drugs and other information of the hospitalized patients,distribution of Western and Chinese drugs responsible for DILI was compared;differences in clinical data between patients of different clinical types were analyzed;possible risk factors associated with DILI were explored.Results:Clinical symptoms with incidence > 50%were weakness,poor appetite and dark urine in descending order.Cholestatic patients had the highest alkaline phosphatase(ALP) and prothrombin time activity(PTA)levels(P < 0.05).Proportion of patients with Chinese drug-induced DILI was up to 60.6%.Meanwhile,common Western drugs responsible for DILI included antituberculotics,antipsychotics,nonsteroidal anti-inflammatory drugs(NSAIDs),etc.OR values for DILI related factors such as hepatobiliary diseases,immune dysfunction,diabetes,hypertension,chronic alcohol consumption and age > 45 years were 6.552,6.130,3.774,2.801,2.002 and 1.838,respectively.Conclusions:Those who manifest weakness,nausea,vomiting,loss of appetite,liver discomfort and other symptoms or demonstrate abnormal liver function during or after intake of drugs suspected of causing liver injury should all be given high attention.Hepatobiliary diseases,diabetes,hypertension,advanced age,chronic alcohol consumption and immune dysfunction are likely to increase drug susceptibility,and more prone to cause liver injury.In clinical practice,possibility of DILI should be considered firstly for liver dysfunctional patients
Objective To comprehensively assess the clinical characteristics,laboratory indices,hepatotoxic drugs and risk factors concerning drug-induced liver injury(DILI).Methods:Data of patients who were hospitalized with a first diagnosis of DILI were collected for systematic retrospective study.Based on the clinical symptoms,laboratory indices,underlying diseases,hepatotoxic drugs and other information of the hospitalized patients,distribution of Western and Chinese drugs responsible for DILI was compared;differences in clinical data between patients of different clinical types were analyzed;possible risk factors associated with DILI were explored.Results:Clinical symptoms with incidence > 50%were weakness,poor appetite and dark urine in descending order.Cholestatic patients had the highest alkaline phosphatase(ALP) and prothrombin time activity(PTA)levels(P < 0.05).Proportion of patients with Chinese drug-induced DILI was up to 60.6%.Meanwhile,common Western drugs responsible for DILI included antituberculotics,antipsychotics,nonsteroidal anti-inflammatory drugs(NSAIDs),etc.OR values for DILI related factors such as hepatobiliary diseases,immune dysfunction,diabetes,hypertension,chronic alcohol consumption and age > 45 years were 6.552,6.130,3.774,2.801,2.002 and 1.838,respectively.Conclusions:Those who manifest weakness,nausea,vomiting,loss of appetite,liver discomfort and other symptoms or demonstrate abnormal liver function during or after intake of drugs suspected of causing liver injury should all be given high attention.Hepatobiliary diseases,diabetes,hypertension,advanced age,chronic alcohol consumption and immune dysfunction are likely to increase drug susceptibility,and more prone to cause liver injury.In clinical practice,possibility of DILI should be considered firstly for liver dysfunctional patients
引文
[1]Danan G,Benichou C.Causality assessment of adverse reactions to drugs-1.Anovel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries[J].J Clin Epidemiol,1993,46(11):1323-1330.
[2]Danan G,Benichou C.Causality assessment of adverse reactions to drugs-1.A novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries[J].J Clin Epidemiol,1993,46(11):1323-1330.
[3]Navarro VJ,Senior JR.Drug-related hepatotoxicity[J].N Eng J Med,2006,354(7):731-739.
[4]张曙云,黄类,俞小忠,等.肝功能异常与代谢综合征的关系中国慢性病预防与控制[J].2008(4):393-395.
[5]Baig NA,Herrine SK,Rubin R.Liver disease and diabetes mellitus[J].Clin Lab Med,2001,21(1):193-207.
[6]刘会领,罗雁,梅玫,等.免疫机制在药物性肝损伤中的作用研究进展[J].实用医学杂志,2012,28(5):852-853.
[7]中华医学会结核病学分会.抗结核药所致药物性肝损伤诊断与处理专家建议[J].中华结核和呼吸杂志,2013,36(10):732-736.
[8]刘玉兰,王晶桐.老年人药物性肝损害的诊治[J].中华老年医学杂志,2009,28(4);274-275.
[9]Cotreau MM,von Moltke LL,Greenblatt DJ.The influence of age and sex on the clearance of cytochrome P450 3A substrates[J].Clin Pharmacokinet,2005,44(1):33-60.
[10]Lewis JH,Mortensen ME,Zweig S.Efficacy and safety of highdose pravastatin in hypercholesterolemic patients with wellcompensated chronic liver disease:results of a prospective.randomized,double-blind,placebo-controlled,multicentertrial[J].Hepatology,2007,46(5):1453-1463.
[11]Russmann S,Jetter A,Kullak-Ublick GA.Pharmacogenetics of drug-induced liver injury.Hepatology,2010,52:748-761.
[2]Danan G,Benichou C.Causality assessment of adverse reactions to drugs-1.A novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries[J].J Clin Epidemiol,1993,46(11):1323-1330.
[3]Navarro VJ,Senior JR.Drug-related hepatotoxicity[J].N Eng J Med,2006,354(7):731-739.
[4]张曙云,黄类,俞小忠,等.肝功能异常与代谢综合征的关系中国慢性病预防与控制[J].2008(4):393-395.
[5]Baig NA,Herrine SK,Rubin R.Liver disease and diabetes mellitus[J].Clin Lab Med,2001,21(1):193-207.
[6]刘会领,罗雁,梅玫,等.免疫机制在药物性肝损伤中的作用研究进展[J].实用医学杂志,2012,28(5):852-853.
[7]中华医学会结核病学分会.抗结核药所致药物性肝损伤诊断与处理专家建议[J].中华结核和呼吸杂志,2013,36(10):732-736.
[8]刘玉兰,王晶桐.老年人药物性肝损害的诊治[J].中华老年医学杂志,2009,28(4);274-275.
[9]Cotreau MM,von Moltke LL,Greenblatt DJ.The influence of age and sex on the clearance of cytochrome P450 3A substrates[J].Clin Pharmacokinet,2005,44(1):33-60.
[10]Lewis JH,Mortensen ME,Zweig S.Efficacy and safety of highdose pravastatin in hypercholesterolemic patients with wellcompensated chronic liver disease:results of a prospective.randomized,double-blind,placebo-controlled,multicentertrial[J].Hepatology,2007,46(5):1453-1463.
[11]Russmann S,Jetter A,Kullak-Ublick GA.Pharmacogenetics of drug-induced liver injury.Hepatology,2010,52:748-761.