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107例中药与化学药致药物性肝损伤的回顾性分析
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| 篇名： | 107例中药与化学药致药物性肝损伤的回顾性分析 |
| TITLE： | |
| 摘要： | 目的：为临床合理用药提供参考。方法：将我院肝病科2011年1月－2015年12月临床诊断为药物性肝损伤（DILI）的107例患者按照所使用的药物类型分为中药组与化学药组，对两组患者DILI临床特征、预后、致DILI药物种类等进行对比分析。结果：中药所致的DILI共47例，主要为保健与美容用药（19.1％）、风湿与关节病用药（14.9％）和皮肤科用药（10.6％）；化学药所致的DILI共60例，主要为抗肿瘤药（21.7％）、抗微生物药（20.0％）和抗结核病药（11.7％）。中药组与化学药组患者性别、平均年龄、初始用药至发病时间和临床分型比较，差异均无统计学意义（P＞0.05）；两组患者临床表现大多相似，但中药组乏力更为常见，差异有统计学意义（P＜0.05）；中药组患者治疗前肝功能指标丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）和总胆红素（TBIL）水平均高于化学药组，且ALT、TBIL差异有统计学意义（P＜0.05）；中药组患者肝损伤程度重于化学药组，差异有统计学意义（P＜0.05）。治疗后，两组患者临床转归和预后肝功能指标比较，差异均无统计学意义（P＞0.05）。结论：医师和临床药师应加强协作，严格掌握用药指征并开展药品不良反应监测，对DILI高发的药物进行血药浓度监测，尤其应注意中药的肝毒性，以减少DILI的发生，保证临床用药的安全性。 |
| ABSTRACT： | OBJECTIVE： To provide reference for rational drug use. METHODS： 107 patients with drug-induced liver injury （DILI） admitted to liver disease department of our hospital during Jan. 2011 to Dec. 2015 were divided into TCM group and chemical medicine group according to the type of medicine. DILI clinical characteristics， prognosis， medicine types of DILI were compared and analyzed between 2 groups. RESULTS： 47 cases of DILI were induced by TCM， which mainly were health care and body beauty medicines （19.1％）， rheumatism and arthritis medicines （14.9％） and dermatological medicines （10.6％）. 60 cases of DILI were induced by chemical medicine， which mainly were antineoplastics （21.7％）， antimicrobial （20.0％） and antituberculotics （11.7％）. Gender， average age， the time from primary medication to disease attack and clinical classification were no significant difference between 2 groups（P＞0.05）. The clinical manifestations of the 2 groups were similar， except that fatigue was more common in the TCM group， with statistical significance（P＜0.05）. The liver function indicators of TCM group as ALT， AST， TBIL and ALP were higher than those of chemical medicine group， while ALT and TBIL were significantly different between 2 groups（P＜0.05）. The liver injuries were more serious in the TCM group than in chemical medicine group， with statistical significance （P＜0.05）. After treatment， the prognosis and the prognosis of liver function indicator in 2 groups were not statistically significant（P＞0.05）. CONCLUSIONS： Doctors and pharmacists should cooperate to master medication indication strictly， develop ADR monitoring and conduct blood concentration monitoring of high-risk DILI medicines， especially the hepatotoxicity of TCM so as to reduce the occurrence of DILI and guarantee the safety of clinical drug use. |
| 期刊： | 2016年第27卷第23期 |
| 作者： | 陈智娴，秦刚 |
| AUTHORS： | CHEN Zhixian，QIN Gang |
| 关键字： | 药物性肝损伤；中药；化学药；临床特征；回顾性分析 |
| KEYWORDS： | Drug-induced liver injury； TCM； Chemical medicine； Clinical features； Retrospective analysis |
| 阅读数： | 263 次 |
| 本月下载数： | 4 次 |
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