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185例药物性肝损伤临床回顾性研究
Retrospective Study of 185 Patients with Drug induced Liver Injury
  
DOI:
中文关键词:  药物性肝损伤  回顾性研究  合理用药
英文关键词:Drug induced liver damage  Retrospective study  Rational drug use
基金项目:2018年上海市临床药学重点专科建设项目(区属)[编号:沪卫计药政(2018)9号],上海市药学会上海医院药学科研项目(编号:2018-YY-11)
作者单位
高悦 方维军 张艳丽 上海市松江区中心医院药剂科 上海 201600 
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中文摘要:
      摘 要 目的:探讨药物性肝损伤(DILI)临床特点,为临床防治DILI提供参考。方法:对上海某医院2017~2018年185例DILI住院患者进行回顾性分析,统计分析DILI患者的年龄、性别、过敏史和肝病史,可疑药物及其关联性评价,DILI的临床症状、严重程度、临床分型和转归,保肝药物使用情况等临床资料。结果:185例DILI住院患者男女比例1 ∶〖KG-*2〗1.60;60岁以上老年患者占比最高;70例(37.84%)有肝病史。致DILI可疑药物中,中成药及中药饮片116例次(44.96%);西药例次最多的是抗结核药(34例次,13.18%)。可疑药物与肝损伤因果关系的RUCAM量表评价结果以很可能(160例次,62.02%)为主。DILI中肝细胞损伤型(119例,64.32%)比例最高;严重程度分级以1级肝损伤(141例,76.22%)为主。不同年龄性别患者DILI临床分型及严重程度差异无统计学意义(P>0.05)。DILI患者两联及以上保肝药物治疗达155例(83.78%),与指南存在较大差异。结论:医务人员需加深对DILI的认识,同时需加大对中药制剂致DILI的宣传,促进临床合理用药。
英文摘要:
      ABSTRACT Objective:To explore the clinical characteristics of drug induced liver injury (DILI), and to provide reference for clinical prevention and treatment of DILI. Methods:A retrospective analysis was conducted on 185 cases of DILI inpatients in a Shanghai hospital from January 2017 to December 2018. The age, gender, past allergy history and liver disease history of DILI patients, suspicious drugs and their associated evaluation, clinical symptoms, severity, clinical classification and outcome of DILI patients, and the use of liver protection drugs were statistically analyzed. Results: Ratio of male to female was 1 ∶〖KG-*2〗1.60; elderly patients over 60 years old accounted for the highest proportion; 70 cases (37.84%) had a history of liver disease. 116 cases (44.96%) of DILI were caused by Chinese patent medicine and Chinese herbal decoction pieces. The most cases of DILI induced by western medicine were 34 cases (13.18%) of anti tuberculosis drugs. According to Roussel Uclaf (RUCAM) causality assessment method, the causality correlation assessment results of drugs and liver, injury were mostly probable (160 cases, 62.02%). The proportion of 119 cases (64.32%) with hepatocellular injury was the highest. Grade 1 liver lesion was the most severe grade, with 141 cases (76.22%). There were no statistically significant differences in clinical classification and severity of DILI among patients of different ages and genders (P>0.05). There were 155 cases (83.78%) of patients with DILI treated with two or more hepatoprotection drugs, which was significantly different from the guidelines. Conclusion:Medical staff should deepen their understanding of DILI, and at the same time increase the publicity of DILI caused by traditional Chinese medicine preparations, so as to promote the reasonable use of DILI by the public.
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