本文選題：藥物性肝損害 + 兒童　； 參考：《中國藥房》2017年32期

【摘要】：目的:了解目前我國兒童藥物性肝損傷(DILI)的流行病學(xué)特點,為減少藥品不良反應(yīng)提供參考。方法:以"肝損傷""肝損害""肝毒性""肝炎""肝病""藥物性""兒童"為關(guān)鍵詞,檢索2007-2016年中國知網(wǎng)、萬方數(shù)據(jù)庫的國內(nèi)相關(guān)文獻,詳細記錄文獻中DILI患兒的臨床資料并進行分析。結(jié)果:共檢索到文獻363篇,最終納入有效文獻13篇,涉及665例患兒。其中,男性424例(63.76%),女性241例(36.24%),男女比例為1.76∶1;患兒年齡最小1月,最大14歲,平均7.87歲,其中7歲以上337例,占50.68%。患兒基礎(chǔ)疾病前3位為呼吸道感染40例(31.50%)、血液病29例(22.83%)和腫瘤14例(11.02%)。導(dǎo)致兒童DILI的藥物種類前3位為抗菌藥物(245例,34.41%)、中藥(143例,20.08%)和解熱鎮(zhèn)痛藥(113例,15.87%)。DILI發(fā)生時間以用藥4周內(nèi)多見(332例,82.18%);臨床分型以肝細胞型為主(382例,65.30%);肝損害嚴重程度主要為輕中度(505例,86.32%),重癥以上的80例(13.68%),其中包括31例(5.30%)肝衰竭。臨床癥狀主要表現(xiàn)為納差、黃疸、惡心嘔吐、乏力和腹部不適;經(jīng)停藥及治療后,96.54%的患兒明顯好轉(zhuǎn)或治愈,死亡4例(0.60%)。結(jié)論:在合理用藥的前提下,有必要對造成兒童DILI較多的抗菌藥物、中藥和解熱鎮(zhèn)痛藥進行用藥宣教及監(jiān)護,重視患兒過敏史及評估肝外癥狀進展,在發(fā)生ADR時應(yīng)及時停藥干預(yù)以改善預(yù)后。
[Abstract]:Objective: to investigate the epidemiological characteristics of drug induced liver injury (DILI) in children in China and to provide reference for reducing adverse drug reactions. Methods: using "liver injury", "liver injury", "liver injury", "liver toxicity", "hepatitis", "liver disease", "drug nature" and "children" as the key words, we searched the relevant literatures in China from 2007 to 2016 in Wanfang database. The clinical data of children with DILI were recorded and analyzed in detail. Results: a total of 363 articles were retrieved, and 13 effective ones were included, involving 665 children. Among them, 424 cases were male and 241 cases were female, the ratio of male to female was 1.76: 1, the age of the child was 1 month, the maximum was 14 years old, the average was 7.87 years old, 337 cases were over 7 years old, accounting for 50.68%. The first 3 cases were respiratory tract infection (n = 40), hematologic diseases (n = 29) and tumor (n = 14). The first three drugs leading to DILI in children were 245 cases of antimicrobial agents (34.41%), 143 cases of Chinese medicine (20.08 cases) and 113 cases of antipyretic analgesics (113 cases). There were 332 cases (82.18%) in the four weeks after treatment; 382 cases were classified as hepatocyte type (n = 382) and 65.30% (n = 65.30). The main degree of liver failure was 86.32 in 505 cases of mild to moderate degree, and 13.68% in 80 cases of more severe cases, including 31 cases of liver failure (5.30%). The main clinical symptoms were anorexia, jaundice, nausea and vomiting, fatigue and abdominal discomfort. Conclusion: under the premise of rational use of drugs, it is necessary to educate and monitor the use of antibiotics, traditional Chinese medicine and antipyretic analgesics, pay attention to the allergic history of children and evaluate the progress of extrahepatic symptoms. In case of ADR, the intervention should be stopped in time to improve the prognosis.
【作者單位】： 玉林市婦幼保健院藥劑科;玉林市婦幼保健院醫(yī)務(wù)科;
【分類號】：R725.7

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