本文選題：藥物性肝損傷　切入點(diǎn)：臨床調(diào)查　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的隨著現(xiàn)代疾病譜的變化和新藥的廣泛臨床應(yīng)用,臨床藥物性肝損傷病例呈逐年上升態(tài)勢(shì)。與國(guó)外以抗生素、消炎鎮(zhèn)痛類(lèi)藥物、抗結(jié)核藥物等西藥為主引起藥物性肝損傷(Drug-induced Liver Injury,DILI)不同的是,國(guó)內(nèi)中草藥、保健品、膳食添加劑引起肝損傷病例占比高,藥物致肝衰竭等嚴(yán)重病例時(shí)有發(fā)生。對(duì)DILI的診斷和治療特別是中草藥相關(guān)肝損傷(herb-induced liver injury,HILI)容易被患者本人甚至臨床醫(yī)生忽視或誤診。本研究的目的是通過(guò)對(duì)HILI臨床病例文獻(xiàn)進(jìn)行匯總分析和對(duì)“真實(shí)世界”因DILI住院患者的驗(yàn)證性臨床回顧性病例系列研究,對(duì)DILI的影響因素、臨床表現(xiàn)及分型、藥物治療前后臨床指標(biāo)變化等匯總分析,為臨床用藥提供參考。對(duì)象和方法(1)文獻(xiàn)分析:通過(guò)計(jì)算機(jī)檢索MEDLINE、Pubmed、中國(guó)知網(wǎng)等數(shù)據(jù)庫(kù)和手工查閱的方式查找2000年1月1日至2016年12月31日國(guó)內(nèi)外公開(kāi)發(fā)表的關(guān)于HILI文獻(xiàn),對(duì)HILI臨床表現(xiàn)、基礎(chǔ)疾病及藥源性損害等情況進(jìn)行研究;(2)回顧性病例系列研究:對(duì)安徽醫(yī)科大學(xué)第一附屬醫(yī)院自2013年9月1日至2016年8月31日共3年期間DILI住院病例進(jìn)行回顧性調(diào)查分析。對(duì)患者的病程、可疑藥物、治療方案、預(yù)后等進(jìn)行總結(jié)分析。結(jié)果(1)文獻(xiàn)分析共納入HILI相關(guān)文獻(xiàn)16篇,1696例病例,男女比例=1:1.81,平均年齡(46.12±5.62)歲,從用藥到發(fā)病平均天數(shù)31.5天,住院治療周期平均21.1天,治療有效率90.54%,臨床分型以肝細(xì)胞損傷型為主,主要癥狀有黃疸(32.7%)、胃腸道反應(yīng)(25.2%)、乏力(23.5%)和納差(13.6%),患者基礎(chǔ)疾病前三位分別是皮膚疾病、心血管疾病、骨關(guān)節(jié)疾病,在可辨認(rèn)成份的引發(fā)肝損傷中草藥中排名前三位的分別是何首烏、補(bǔ)骨脂、延胡索。(2)3年住院病例的回顧調(diào)查共收集到315份病例,患者平均年齡(48.74±15.30)歲,男女比例=1:1.30,引起藥物以中藥為主(173例,含中草藥、中成藥),第一次用藥到發(fā)病平均周期為(25.72±22.14)天,41~70歲為該病的高發(fā)期,40歲以上病例占比73%,以肝細(xì)胞損傷型病例為主,臨床治療以保肝降酶退黃為主,99.05%病例預(yù)后均較好。結(jié)論文獻(xiàn)分析及臨床回顧性病例系列研究表明,農(nóng)村人群和受教育水平較低人群、中老年和女性人群更易罹患DILI,男女因疾病譜等原因用藥有特殊性,多數(shù)患者有兩種以上藥物用藥史,中西藥物合用現(xiàn)象突出,從用藥到發(fā)病潛伏期較長(zhǎng),應(yīng)用相關(guān)藥物應(yīng)注意檢測(cè)肝功能指標(biāo)。肝損傷類(lèi)型以肝細(xì)胞損傷型為主,國(guó)內(nèi)HILI占比高。保肝降酶治療一般預(yù)后較好。中藥較西藥引起的DILI的ALT、AST、Hb等肝功能指標(biāo)更高,肝損傷更嚴(yán)重。
[Abstract]:Objective with the change of modern disease spectrum and the wide clinical application of new drugs, the clinical cases of liver injury caused by drugs are increasing year by year. Drug-induced Liver injury (Drug-induced Liver injury induced by Drug-induced Liver injury) is different from traditional Chinese herbal medicine, health products and dietary additives, and the proportion of cases of liver injury caused by Chinese herbal medicine, health products and dietary additives is high. The diagnosis and treatment of DILI, especially herb-induced liver injuryHILI, are easy to be ignored or misdiagnosed by the patients themselves or even the clinicians. The purpose of this study is to study the diagnosis and treatment of DILI through the clinical practice of HILI. Case literature analysis and validation clinical retrospective case series study of "real world" inpatients with DILI, The influencing factors, clinical manifestations and types of DILI, the changes of clinical indexes before and after drug treatment, etc. To provide references for clinical use of drugs. Objects and methods 1) Literature analysis: the HILI literature published at home and abroad from January 1st 2000 to December 31st 2016 was searched by means of computer retrieval of MEDLINE online, Chinese knowledge Network and other databases, and manual reference was used to find out the literature published at home and abroad from January 1st 2000 to December 31st 2016. For the clinical manifestations of HILI, A retrospective study on basic Diseases and Drug-induced damage: retrospective study on the hospitalized cases of DILI in the first affiliated Hospital of Anhui Medical University during the three-year period from September 1st 2013 to August 2016. Investigation and analysis. The course of disease of the patient, Results A total of 16 cases of HILI were included in the literature analysis. The ratio of male to female was 1: 1.81, with an average age of 46.12 鹵5.62 years, and the average days from medication to onset were 31.5 days. The average hospitalization period was 21.1 days, and the effective rate was 90.54. The main clinical types were hepatocyte injury. The main symptoms were jaundice, stomach reaction, stomach and intestine reaction, stomach and intestine reaction, and anorexia. The first three basic diseases were skin disease and cardiovascular disease, respectively. Bone and joint diseases, the top three Chinese herbal medicines for identifying liver injury were Polygonum multiflorum, Psoralen multiflorum, Corydalis corydalis. 2) A total of 315 cases were collected in 3 years. The average age of the patients was 48.74 鹵15.30 years old, and the average age of the patients was 48.74 鹵15.30 years old, and the average age of the patients was 48.74 鹵15.30 years. The ratio of male to female was 1: 1.30. 173 cases were caused by traditional Chinese medicine, including Chinese herbal medicine and Chinese patent medicine. The average period from the first medication to the onset of the disease was 25.72 鹵22.14 days. The proportion of cases over 40 years of age in the high incidence period of the disease was 73.The main type was hepatocyte injury. The prognosis of 99.05% cases was good. Conclusion the literature analysis and clinical retrospective case series studies show that the rural population and the population with lower education level have better prognosis. The middle-aged and elderly people and the female population are more likely to suffer from DILI. Because of disease spectrum and other reasons, most patients have more than two kinds of drug use history. The phenomenon of combination of Chinese and western drugs is prominent, from medication to onset incubation period is longer. We should pay attention to the detection of liver function indexes in the application of related drugs. The main type of liver injury is hepatocyte injury type, the proportion of HILI is high in our country. The liver protective enzyme therapy is generally good in prognosis. The liver function index of Chinese medicine is higher than that of DILI caused by western medicine, such as alt, ASTH, HB and so on. Liver injury is more severe.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R575

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