儿童药物性肝损伤34例分析*

doi:10.3969/j.issn.1672-5069.2016.05.026

实用肝脏病杂志 ›› 2016, Vol. 19 ›› Issue (5): 607-609.doi: 10.3969/j.issn.1672-5069.2016.05.026

儿童药物性肝损伤34例分析^*

杜水仙, 卢琳琳, 苗英霞, 刘洋, 李昌飞, 辛永宁, 宣世英

266021 山东省青岛市青岛大学（杜水仙,刘洋,苗英霞,李昌飞）; 青岛市市立医院消化内二科（芦琳琳,宣世英,辛永宁）

收稿日期:2016-03-20 出版日期:2016-09-10 发布日期:2016-10-12
通讯作者: 辛永宁,E-mail: xinyongning@163.com
作者简介:杜水仙,女,24岁,硕士研究生。主要从事肝病防治研究。E-mail：15866813623@163.com
基金资助:
国家科技部十二五“重大新药创制”科技重大专项课题(2012ZX09303-001)

Features of children with drug-induced liver injury:An analysis of 34 cases

Du Shuixian, Lu Linlin, Miao Yingxia, et al.

Medical College of Qingdao University,Qingdao 266021,Shandong Province,China

Received:2016-03-20 Online:2016-09-10 Published:2016-10-12

摘要/Abstract

摘要： 目的总结儿童药物性肝损伤（DILl）患者的临床特征及转归,以提高对儿童DILI的认识。方法回顾性分析本院2009年1月~2015年12月诊治的DILI的年龄<14岁的患儿的临床资料,依据RUCAM量表诊断。采用ELISA法检测血清HAV、HBV、HCV、HEV、CMV、EBV、单纯疱疹病毒、微小病毒B19标记物。结果在34例小儿DILI患者中,男性25例,女性9例;年龄在5个月~14岁,平均年龄（8.3±4.1）岁。平均住院日为22.0 d,其中38.24%患儿有呼吸道感染病史,35.29%患儿以恶心、消化不良等消化道症状为首发症状;肝细胞型24例（70.59%）,胆汁淤积型3例（8.82%）,混合型7例（20.59%）;用药种类以抗生素为最常见（26.47%）,在中草药中以麻黄（11.76%）最常见。结论儿童DILI大多是由于治疗呼吸道感染而应用的抗生素和中草药所导致的。

关键词: 药物性肝损伤, 抗生素, 麻黄, 儿童

Key words: Drug-induced liver injury, Antibiotics, Chinese herbal medicine, Children

杜水仙, 卢琳琳, 苗英霞, 刘洋, 李昌飞, 辛永宁, 宣世英. 儿童药物性肝损伤34例分析^*[J]. 实用肝脏病杂志, 2016, 19(5): 607-609.

Du Shuixian, Lu Linlin, Miao Yingxia, et al.. Features of children with drug-induced liver injury:An analysis of 34 cases[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2016, 19(5): 607-609.

参考文献

[1] Amin MD,Harpavat S,Leung DH. Drug-induced liver injury in children. Curr Opin Pediatr,2015,27（5）:625-633.
[2] Yun Z,Li YG,Wu JB,et al. Causes,features,and outcomes of drug-induced liver injury in 69 children from China. Gut Liver,2015,9（4）:525-533.
[3] Danan G,Benichou E. Causality assessment of adverse reactions to drugs-I. A novel method based on the conclusions of international consensus meetings:application to drug-induced liver injuries. J Clin Epidemiol,1993,46（11）:1323-1330.
[4] Standardization of definitions and criteria of causality assessment of adverse drug reactions. Drug-induced liver disorders:report of an international consensus meeting. Int J Clin Pharmacol Ther Toxic,1990,28:317-322.
[5] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南. 肝脏,2015,10:750-766.
[6] Pineiro-Carrero VM,Pineiro EO. Liver. Pediatrics,2004,113:1097-1106.
[7] Andrade RJ,Lucena MI,Fernández MC,et al. Drug-induced liver injury:an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology,2005,129:512-521.
[8] 王淑珍,高珊,刘燕敏,等. 31例小儿药物性肝损伤的临床特点分析. 中华肝脏病杂志,2012,20（3）:193-195.
[9] Kleiner DE,Chalasani NP,Lee WM,et al. Hepatic histological findings in suspected drug-induced liver injury:systematic evaluation and clinical associations. Hepatology,2014,59:661-670.
[10] Molleston JP,Fontana RJ,Lopez MJ,et al. Characteristics of idiosyncratic drug-induced liver injury in children:results from the DILIN prospective study. J Pediatr Gastroenterol Nutr,2011,53:182-189.
[11] Devarbhavi H,Karanth D,Prasanna KS,et al. Drug-induced liver injury with hypersensitivity features has a better outcome:a single-center experience of 39 children and adolescents. Hepatology,2011,54:1344-1350.
[12] Hunt CM. Mitochondrial and immunoallergic injury increase risk of positive drug rechallenge after drug-induced liver injury:a systematic review. Hepatology,2010,52:2216-2222.
[13] Schoepfer AM,Engel A,Fattinger K,et al. Herbal does not mean innocuous:ten cases of severe hepatotoxicity associated with dietary supplements from herbal products. J Hepatol,2007,47:521-526.
[14] Li FY,Li J,Xiao XH. Research status of herbal drug-induced liver injury. Chin J Tradit Chin Med Pharmacol,2009,24:265-269.
[15] Bunchorntavakul C,Reddy KR. Review article:herbal and dietary supplement hepatotoxicity. Aliment Pharmacol Ther,2013,37:3-17.
[16] Skoulidis F,Alexander GJ,Davies SE. Mahuang associated acute liver failure requiring liver transplantation. Eur J Gastroenterol Hepatol,2005,17:581-584.
[17] Liu HC,Liu HY. The liver damage of herbs and the other botanical herbs. Chin Hepatol,2001,6:52-53.
[18] Nam SW,Baek JT,Lee DS,et al. A case of acute cholestatic hepatitis associated with the seeds of Psoralea corylifolia （Boh-Gol-Zhee）. Clin Toxicol （Phila）,2005,43:589-591.
[19] Dong Y,Wang J,Yang Q,et al. Current status on the interaction of cytochrome P450 and metabolism of Chinese materia medica. Chin J Inf Tradit Chin Med,2011,18:100-103.
[20] Guerra MC,Speroni E,Broccoli M,et al. Comparison between Chinese medical herb Pueraria lobata crude extract and its main isoflavone puerarin antioxidant properties and effects on rat liver CYP-catalysed drug metabolism. Life Sci,2000,67:2997-3006.
[21] Bjornsson HK,Olafsson S,Bergmann OM,et al. A prospective study on the causes of notably raised alanine aminotransferase （ALT）. Scand J Gastroenterol,2016,51（5）:594-600.
[22] Bjornsson E. Drug-induced liver injury:Hy , s rule revisited. Clin Pharmacol Ther,2006,79（6）:521-528.
[23] Verma S,Kaplowitz N. Diagnosis,management and prevention of drug-induced liver injury. Gut,2009,58:1555-1564.

儿童药物性肝损伤34例分析^*

Features of children with drug-induced liver injury:An analysis of 34 cases

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	吴欣, 郭杨志, 杜霄壤, 吴孟晋, 朱云, 冯兴中. 75例中药诱导的肝损伤患者临床特征分析*[J]. 实用肝脏病杂志, 2019, 22(5): 668-671.
[2]	张兰华, 邵琴, 夏振娟. 非酒精性脂肪性肝病儿童血清25-（OH）D3和IL-17水平变化初步研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 522-525.
[3]	王宝丹, 李萌, 高于. α-干扰素治疗慢性乙型肝炎儿童疗效及其影响疗效的因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 345-348.
[4]	刘立伟,赵新颜. 药物性肝损伤临床与组织病理学特点[J]. 实用肝脏病杂志, 2019, 22(2): 160-163.
[5]	黄春洋,单晶,廖慧钰,黄云丽,韩莹,张小丹,杜晓菲,任美欣,边新渠,刘燕敏. 甲基强的松龙治疗药物性肝损伤患者临床及实验室特点分析^*[J]. 实用肝脏病杂志, 2019, 22(2): 208-211.
[6]	吴秀欣,张惠勇,张凯. 抗结核药物所致肝损伤患者血浆MiRNA-4284水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2019, 22(2): 212-215.
[7]	宋芳娇,朱冰,吕飒,田华,王海波,辛绍杰,游绍莉. 314例药物性肝衰竭患者临床特征分析^*[J]. 实用肝脏病杂志, 2019, 22(2): 216-219.
[8]	孙文静, 陈东风. UCAM和Maria诊断标准用于评估1352例中国人药物性肝损伤文献分析[J]. 实用肝脏病杂志, 2018, 21(6): 881-884.
[9]	曹海霞, 范建高. 欧洲儿童肝豆状核变性诊疗推荐意见简介[J]. 实用肝脏病杂志, 2018, 21(4): 502-504.
[10]	张财源, 李金凝, 刘欢欢, 汪登斌. PRETEXT分期系统对儿童肝母细胞瘤病理学分型和疗效评估的价值分析^*[J]. 实用肝脏病杂志, 2018, 21(4): 505-508.
[11]	佟欣, 樊华. 双环醇治疗胃癌化疗所致肝损伤患者肝功能指标的变化[J]. 实用肝脏病杂志, 2018, 21(4): 625-626.
[12]	刘聪, 王婷婷, 左莉莉, 甄萍. 近3年住院患者药物性肝损伤状况调查[J]. 实用肝脏病杂志, 2018, 21(4): 639-640.
[13]	雷彦明, 旦增罗布, 顿珠次仁. 儿童肝母细胞瘤CT影像特征分析[J]. 实用肝脏病杂志, 2018, 21(4): 649-650.
[14]	刘靓懿, 宿冬远. 药物性肝损伤与自身免疫性肝炎临床和肝组织病理学特征比较研究[J]. 实用肝脏病杂志, 2018, 21(3): 463-464.
[15]	陈杰, 范作鹏, 梁珊, 聂巍, 仇丽霞, 杨海霞, 林伟, 刘义荣, 张晶, 胡中杰. 合并慢性胆汁淤积性肝病对慢性药物性肝损害患者临床表现及对治疗应答的影响*[J]. 实用肝脏病杂志, 2017, 20(6): 720-723.