论文部分内容阅读
目的:调查消核片相关肝损害的临床特点及发生原因,为临床合理用药提供参考。方法:以“消核片”为检索词,检索《CHKD期刊全文数据库》(1994-2009),《中国生物医学文献数据库(CBM)》(1978-2009),收集分析消核片相关肝损害的病例报告。结果:共收集到194例,均为女性患者,年龄17～55岁。68例标明用药剂量,2～7片/次,3次/d,用药时间为14～180d。患者用药50d左右出现恶心、腹胀等消化道症状;用药30～141d出现皮肤、巩膜黄染;生化检查示:丙氨酸转氨酶(ALT)68～1700U/L;天冬氨酸转氨酶(AST)40～1260U/L;总胆红素(TBil)8.0～795.4μmol/L;直接胆红素(DBil)2.3～391.8μmol/L。194例中有10例行肝组织病理检查,呈不同程度的肝细胞肿胀、胞质疏松、气球样变及肝细胞坏死。大多数患者在停药后10d至4个月内逐渐恢复正常,其中190例(97.9%)临床痊愈,3例(1.5%)好转,1例(0.5%)急性肝衰竭患者死于感染性休克。结论:消核片可引起肝损害,多为可逆性;其发生可能与用药剂量及疗程有关;肝病患者应避免使用该药;用药过程中应密切监测肝功能。
Objective: To investigate the clinical characteristics of ablation-related liver damage and its causes, provide a reference for clinical rational use of drugs. Methods: The “CHKD Journal Full-text Database” (1994-2009) and “China Biomedical Literature Database (CBM)” (1978-2009) Damaged case reports. Results: A total of 194 cases were collected, all female patients, aged 17 to 55 years. 68 cases marked dose, 2 to 7 tablets / time, 3 times / d, medication time is 14 ~ 180d. Patients with medication about 50d appear nausea, abdominal distension and other gastrointestinal symptoms; medication 30 ~ 141d appear skin, scleral yellow dye; biochemical tests showed: alanine aminotransferase (ALT) 68 ~ 1700U / L; aspartate aminotransferase ~ 1260U / L; total bilirubin (TBil) 8.0 ~ 795.4μmol / L; direct bilirubin (DBil) 2.3 ~ 391.8μmol / L. In 194 cases of 10 cases of liver biopsy, showed varying degrees of hepatocyte swelling, cytoplasmic loose, balloon-like changes and necrosis of liver cells. The majority of patients returned to normal within 10 days to 4 months after discontinuation, of which 190 (97.9%) recovered clinically, 3 (1.5%) improved, and 1 (0.5%) patients with acute liver failure died of septic shock . Conclusion: Dioxin tablets can cause liver damage, mostly reversible; its occurrence may be related to dosage and course of treatment; patients with liver disease should avoid the drug; medication should be closely monitored during liver function.