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陈红,高水群,肖锦仁,唐静.黄药子及其制剂致药物性肝损伤病例临床分析[J].湖南中医药大学学报,2021,41(9):1442-1446[点击复制] |
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| 黄药子及其制剂致药物性肝损伤病例临床分析 |
| 陈红,高水群,肖锦仁,唐静 |
| (成都医学院第二附属医院·核工业四一六医院中西医结合科, 四川 成都 610057;成都医学院第二附属医院·核工业四一六医院药剂科, 四川 成都 610057;湖南中医药大学药学院, 湖南 长沙 410208) |
| 摘要: |
| 目的 探讨黄药子及其制剂所致药物性肝损伤（drug-induced liver injury，DILI）的原因、治疗及预后情况，为其临床合理用药提供参考。方法 回顾性分析成都医学院第二附属医院2015年1月至2020年10月确诊43例黄药子及其制剂致DILI患者的住院资料，依据国际医学组织理事会制订的DILI临床分型判断标准进行分型，记录其肝功能状况及临床表现，分析临床原因，统计常规保肝治疗、黄药子解毒方联合还原型谷胱甘肽治疗及血浆置换治疗后患者的临床有效率。结果 43例DILI患者临床分型中肝细胞损伤型占20.93%，胆汁淤积型肝损伤占44.19%，混合型肝损伤占34.88%。相比于肝细胞损伤型和混合型，胆汁淤积型患者的总胆红素（TB）和直接胆红素（DB）水平均明显升高（P<0.01）；胆汁淤积型患者的谷丙转氨酶（ALT）、谷草转氨酶（AST）和碱性磷酸酶（ALP）水平均明显高于混合型（P<0.01）。患者肝损伤的临床表现主要以皮肤、巩膜黄染（69.77%），发热（62.79%），纳差、乏力（58.14%）为主；服药时间过长、服药剂量过大为引起肝损伤的主要原因。对于非重症急性肝衰竭患者，采用常规保肝治疗方案与黄药子解毒方联合还原型谷胱甘肽治疗方案的患者临床有效率分别为95.65%、100.00%，差异无统计学意义（P>0.05）。结论 临床使用该类药物时，可引起多种类型的肝损伤，应密切关注使用剂量、使用疗程及患者肝功能变化情况。 |
| 关键词: 黄药子 药物性肝损伤 还原型谷胱甘肽 肝功能 回顾性研究 |
| DOI：10.3969/j.issn.1674-070X.2021.09.023 |
| 投稿时间：2021-06-19 |
| 基金项目:国家自然科学基金面上项目（81874424）。 |
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| Clinical Analysis of Drug-induced Liver Damage Caused by Huangyaozi (Dioscorea bulbifera L.) and Its Preparation |
| CHEN Hong,GAO Shuiqun,XIAO Jinren,TANG Jing |
| (Department of Integrated Traditional Chinese and Western Medicine, The Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, Chengdu, Sichuan 610057, China;Department of Pharmacy, The Second Affiliated Hospital of Chengdu Medical College/Nuclear Industry 416 Hospital, Chengdu, Sichuan 610057, China;Pharmacy School, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China) |
| Abstract: |
| Objective To investigate the causes, treatment and prognosis of drug-induced liver injury (DILI) caused by Huangyaozi (Dioscorea bulbifera L.) and its preparations, so as to provide reference for clinical rational drug use. Methods The hospitalization data of 43 patients diagnosed with DILI caused by Huangyaozi (Dioscorea bulbifera L.) and its preparations from January 2015 to October 2020 in The Second Affiliated Hospital of Chengdu Medical College were retrospectively analyzed. The patients were classified according to the criteria for clinical classification and judgment of DILI formulated by the Council of International Medical Organizations. The liver function status and clinical manifestations were recorded, and the clinical causes were analyzed. After conventional liver protection treatment, Huangyaozi Jiedu Prescription combined with reduced glutathione treatment and plasma exchange treatment, the clinical effective rate was calculated. Results In 43 DILI patients, liver cell injury type accounted for 20.93%, cholestasis liver injury type accounted for 44.19%, and mixed liver injury type accounted for 34.88%; the levels of total bilirubin (TB) and direct bilirubin (DB) in patients with cholestasis type were significantly higher than those in patients with hepatocyte injury type and mixed type (P<0.01); the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in patients with cholestasis type were significantly higher than those in patients with mixed type (P<0.01). The main clinical manifestations were skin and sclera yellow staining (69.77%), fever (62.79%), poor appetite and fatigue (58.14%). The main cause of liver injury was taking medicine for too long and taking too much. For non severe acute liver failure patients, the clinical effective rates of the conventional liver protection treatment and Huangyaozi Jiedu Prescription combined with reduced glutathione treatment were 95.65% and 100.00%, respectively, and there was no statistical significance (P>0.05). Conclusion The clinical use of these drugs can cause a variety of types of liver injury, and it is necessary to pay close attention to the dosage, duration of use and changes in the patient's liver function. |
| Key words: Huangyaozi (Dioscorea bulbifera L.) drug-induced liver injury reduced glutathione liver function retrospective study |
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