儿童药物性肝损害的临床研究

Clinical features of drug-induced liver injury in children

摘要:

目的：探讨儿童药物性肝损害（DILI）的临床特点。方法：采用回顾性描述性研究方法收集5年住院患儿DILI的临床资料，对患儿的一般状况、用药史、临床表现、肝脏损害类型以及原发疾病等相关因素进行分析，探讨儿童DILI的临床特点。结果：641例因肝脏疾病住院的患儿中，DILI患儿64例，占10%。肝脏损害的类型以肝细胞型为主，占81%；引起肝脏损害的药物主要为化疗药物、抗生素、抗结核药物；临床常见的症状及体征有皮疹（16%）、消化道症状（15%）、发热（14%）和肝脏肿大（12%），其中11%的DILI患儿无症状及体征。结论：DILI是住院儿童肝脏损害的常见原因之一，部分DILI患儿仅有肝功能生化指标异常而无症状及体征。儿童DILI以肝细胞型为主，肝脏损害较轻。

Abstract:

OBJECTIVE: To study the clinical features of drug-induced liver injury in children. METHODS: The clinical data of the hospitalized children with drug-induced liver injury over 5 years were retrospectively reviewed. RESULTS: Of 641 cases of hospitalized children with liver injury, there were 64 cases (10%) of drug-induced liver injury. Hepatocellular injury was the most common type of drug-induced liver injury (81%). The major drugs causing drug-induced liver injury included chemotherapy drugs, antibiotics and anti-tuberculosis drugs. Rash (16%), gastrointestinal reaction (15%), fever (14%) and liver intumescence (12%) were common clinical symptoms. A part of patients with drug-induced liver injury (11%) had no symptoms and signs. CONCLUSIONS: Drug-induced liver injury is one of the common causes of liver damage in hospitalized children. Some children with drug-induced liver injury have no symptoms and signs. Hepatocellular injury is a major type of drug-induced liver injury in children, resulting less severe liver damage.