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184例儿童药物性肝损伤的临床特征及转归状况评价
Clinical characteristics and outcomes of drug-induced liver injury in children: a study of 184 cases
文章发布日期:2015年07月08日  来源:  作者:甘雨,董漪,张鸿飞,等  点击次数:1600次  下载次数:276次

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【摘要】:目的 通过对儿童药物性肝损伤(DILI)的临床特征及转归的研究,提高对儿童DILI的认识。方法 收集184例2004年1月-2014年1月于解放军第三〇二医院住院的年龄<16岁的DILI患儿,对其临床和病理资料进行回顾性分析。 结果 儿童各年龄段均可能发生DILI,并可见于婴幼儿,最小2月龄。临床有症状者143例(77.7%),主要表现为食欲减退、眼黄、尿黄等。引起肝损伤的药物主要有:中药(28.3%)、抗菌药(24.5%)、解热镇痛药(19.6%)等。儿童DILI病理特点主要为:嗜酸性粒细胞为主的炎性细胞浸润(78.7%),混合性肝细胞脂肪变性(73.5%),毛细胆管性淤胆(38.7%)。病程中有4例(2.2%)患儿转化为自身免疫性肝炎,29例(15.8%)患儿发生肝衰竭,其中3例肝衰竭患儿死亡。经治疗后,177例(96.2%)患儿肝功能恢复正常出院。结论 儿童DILI可见于各年龄段,引起该病的药物主要以中药、抗菌药、解热镇痛药为主。肝脏病理检查为诊断儿童DILI的重要依据,虽然大多数患儿预后较好,但也应警惕肝衰竭的发生,并注意定期随访。
【Abstract】:Objective To investigate the clinical characteristics and outcomes of drug-induced liver injury (DILI) in children, and to improve the understanding of DILI in children. Methods One hundred and eighty-four children with DILI who were under 16 years and hospitalized in our hospital from January 2004 to January 2014 were enrolled as subjects, and their clinical and pathological data were retrospectively analyzed. Results DILI might occur at any age in children, even at the infant stage, and the youngest patient was only 2 months old. There were 143 patients (77.7%) with clinical symptoms, including loss of appetite, jaundice, and yellow urine. The drugs causing DILI included traditional Chinese medicine (28.3%), antibiotics (24.5%), and anti-inflammatory drugs (19.6%). The pathological characteristics of DILI in children included eosinophils-based inflammatory cell infiltration (78.7%), mixed hepatic steatosis (73.5%), and cholangiolar cholestasis (38.7%). Four patients (2.2%) developed autoimmune hepatitis; twenty-nine patients(15.8%) had liver failure, and three of them died of liver failure. After treatment, 177 patients (96.2%) recovered normal liver function and were discharged. Conclusion DILI may occur at any age in children, and a majority of drugs causing DILI are traditional Chinese medicine, antibiotics, and anti-inflammatory drugs. The pathological examination of liver provides an important basis for the diagnosis of DILI in children. In spite of the benign prognosis in most patients, the incidence of liver failure still needs to be taken into account, and regular follow-up is necessary.
【关键字】:药物性肝损伤;临床特征;预后;儿童
【Key words】:drug-induced liver injury; clinical features; prognosis; child
【引证本文】:甘雨, 董漪, 张鸿飞, 等. 184例儿童药物性肝损伤的临床特征及转归状况评价[J]. 临床肝胆病杂志, 2015, 31(8): 1244-1247.

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