药物性肝损害115例临床分析

目的 总结分析药物性肝损害的临床特点，并探讨防治策略。方法 对115例药物性肝损害进行临床回顾性分析。结果 药物性肝损害分为肝细胞损害型、肝内胆汁瘀积型，停药或减量，并给予保肝药物，肝损害大多可恢复。结论 药物性肝损害是药物严重不良反应之一，及早发现，调整用药是减少药物性肝损害的关键。     

药物性肝损害的诊断与治疗

临床分类:药物性肝损害从发生机制可分为中毒性和变态反应性肝损害。从临床上分为急性与慢性肝损害。临床上常见的是变态反应性肝损害。急性药物性肝损害在病理学上通常分为肝细胞损害型、胆汁淤滞型和混合型。     

建立“肝型并殖吸虫病”临床类型的探讨：附26例报告

近年来,并殖吸虫对肝脏损害的病例报告逐渐增多,尤其在浙江,发现了较多以肝脏损害为突出表现的病例.因此,本文拟就建立"肝型并殖吸虫病"临床类型问题进行探讨.一、"肝型并殖吸虫病"的分型刍议1978年以来,笔者共经治有肝损害的并殖吸虫病32例,根据临床观察,似可分为以下五种类型:(1)突出表现为肝脏损害,其     

药物性肝损害的临床病理分型

药物性肝损害的临床病理分型于皆平湖北医科大学附属第一医院（４３００６０）药物性肝损害的临床表现复杂多样，且常为基本病所掩盖，极易误诊。为指导临床诊断、治疗，可将其分为以下几型。１　急性药物性肝损害１．１肝细胞型　①肝炎型：很多药物可引起肝实质细胞的损...     

布加综合征的肾脏损害

布加综合征(Budd-Chiari syndrome)系肝脏静脉流出道梗阻所致,根据梗阻部位分为肝小静脉、肝大静脉和下腔静脉(IVC)3型,前两型又统称单纯肝静脉型。布加综合征的肾脏损害常被忽视,在肾脏损害的病因分析中也很少考虑到这一因素。我院1991～t997年共收治布加综合征24例,其中单纯肝静脉型5例与病情较轻的IVC 2例无肾脏损害表现,余17例(70.8％)IVC病人有不同程度的肾脏损害,现对该17例作一分析,以探讨布加综合征肾脏损害的临床表现、发病机制、诊断及治疗。     

急性胰腺炎的肝脏损害：附53例临床分析

对住院治疗的５３例急性胰腺炎病例进行临床分析，发现３０例有不同程度的肝损害，占５６．６％，其中急性水肿型胰腺炎的肝损害占５０．０％，急性出血坏死型胰腺炎的肝损害占８８．９％，病死率为５．７％。     

急性胰腺炎的肝脏损害──附53例临床分析

对住院治疗的５３例急性胰腺炎病例进行临床分析，发现３０例有不同程度的肝损害，占５６．６％，其中急性水肿型胰腺炎的肝损害占５０．０％，急性出血坏死型胰腺炎的肝损害占８８．９％，病死率为５．７％。     

乙肝病毒感染肾移植患者的临床观察与治疗

目的 通过对肾移植术后患者肝功损害的原因分析，总结乙肝病毒对肾移植受体肝脏的损害及治疗措施。方法 根据乙肝标志物将患者分为三组：A组（HBsAg＋、HBeAg＋和HBV—DNA＋），B组（HBsAg＋、HBeAg-和HBV—DNA-），C组（HbsAg-、HBeAg-和HBV—DNA-），对其肾移植术后肝功情况进行分析，对不同原因的肝损害采用调整免疫抑制剂量或加用保肝药物并观察效果。结果 A组肝损害发生率41．9％，与C组比较差异有显著性；B组肝损害发生率22．6％，与C组比较差异无显著性。结论 肾移植术后药物性肝损害出现在3个月内，而病毒性肝损害以6个月到2年为多见。合并乙肝病毒感染的肾移植患者更易发生肝损害．通过保肝以及加用拉米夫定使肝功恢复正常。     

非酒精性脂肪肝合并肝功能损害100例临床分析

目的 分析非酒精性脂肪肝（NASH）合并肝功能损害的临床特征。方法 100例存在肝功能损害的NASH患者，根据B超分为轻、中、重度三型，比较三种类型患者异常的肝酶、血脂等指标。结果 NASH患者最为常见增高的肝酶指标是ALT、GGT、AST，但其升高值多在正常上限3倍以下；三种类型NASH患者异常的肝酶、血脂指标、PT、APTT、BMI之间差异均无显著性。结论 NASH合并肝功能损害其肝酶异常值与病情无相关性，但需加强护肝治疗，以减缓病情的进展。     

副肝管不同类型的术中处理：附6例报告

６例副肝管根据其肝外注入部位及与手术关系分为４型，并对各型手术处理方法进行讨论。     

Ketoconazole Associated Hepatotoxicity: A Systematic Review and Meta-analysis

Objective To evaluate the incidence of Ketoconazole associated hepatotoxicity and related factors. Methods Literature retrieval was conducted by using multi-databases for meta-analysis on Ketoconazole associated hepatotoxicity. The data were collected with a standardized form. Overall estimation of incidence of hepatotoxicity for specific study type was calculated by using a DerSimonian-Laird random-effects model owing to the substantial differences among the studies. Results Totally 204 eligible studies were included in the analysis. The incidence of Ketoconazole associated hepatotoxicity was 3.6%-4.2%. The dosage and duration specific subgroup analyses did not show any significant difference among groups, while the age specific subgroup analysis showed the incidence in children and people aged >60 years was 1.4% (95% CI: 0.5%-4.2%) and 3.2% (95% CI: 1.1%-8.7%) respectively. Additionally, the incidence of the hepatotoxicity was higher in people who had oral administration of ketoconazole beyond the provisions of the usage instructions, and the incidence was 5.7% (95% CI: 4.5%-7.2%). Conclusion Ketoconazole associated hepatotoxicity was common. Off-label use might increase the risk of liver damage. Well-designed large sample studies are needed to identify the risk factors in future.     

Drug induced hepatitis with anti-tubercular chemotherapy: Challenges and difficulties in treatment.

Tuberculosis is a major health burden worldwide. In Nepal, it is a significant cause of morbidity and mortality. Although better drugs are available for managing tuberculosis, treatment failure is one of the common problems encountered. Among the various causes which can cause treatment interruption, drug induced hepatotoxicity is a common cause. Isoniazid and Pyrazinamide are the common drugs causing hepatotoxicity. Upon occurrence of hepatotoxicity, the hepatotoxic drugs should be stopped and reintroduced as per the available guidelines. The healthcare professional should also counsel the patients for recognizing the early symptoms due to hepatotoxicity which could prevent morbidity. Key words: Adverse effects, Hepatotoxicity, Tuberculosis.     

抗甲状腺药物致肝损害42例临床分析

目的 :探讨抗甲状腺药物 (ATD)引起肝损害的临床特点、治疗及转归。方法 :对 4 2例因服用ATD致肝损害患者进行回顾性分析。结果 :亚临床肝损害不需停用ATD ,加用保肝药绝大多数 1个月之内治愈 ;显著肝损害者除立即停用ATD外 ,通过保肝、降酶、利胆等综合治疗 ,大多数也可好转或治愈 ,但前者疗效明显高于后者 (P <0 .0 1)。结论 :肝损害可发生于ATD治疗的全过程 ,但绝大多数发生在开始治疗的前 3个月 ,故应常规定期监测肝功能 ,尤其在治疗的前 3个月 ,以避免肝损害的发生。     

酶生物标志物在肝毒性评价中的应用

在新药研发过程中,很多候选药物由于严重的不良反应而遭淘汰,各类不良反应中药物引起的肝毒性最多。肝脏是体内含酶最丰富的器官,通过联合检测血清中酶的变化可以及时了解肝脏的病理生理状态。现就肝毒性传统血清酶生物标志物和潜在的血清酶生物标志物在肝毒性评价中的应用予以综述,以期通过联合检测血清酶,做到早期发现毒性,早采取措施。     

凯西莱防治化疗药物性肝损害临床观察

目的：观察凯西莱（硫普罗宁）在恶性肿瘤患者接受化疗药时对化疗性肝损害的预防和治疗作用。方法：将154例患恶性肿瘤的患者分为两组,预防组78例,在化疗同时加用凯西莱;对照组76例单纯化疗,对出现肝损害的患者（28例）加用凯西莱治疗。结果：预防组肝损害的发生明显低于对照组,有显著性差异（P〈0．01）;对照组中有肝损害的患者加用凯西菜治疗后肝功能指标有明显改善,有显著性差异（P〈0．01）。结论：凯西莱对恶性肿瘤患者化疗性肝损害的预防和治疗疗效显著,值得临床推广。     

常用中药及复方制剂的肝毒性

中药所致肝毒性的临床表现与常见肝病相似,可出现急性肝细胞损害、肝功能异常、血清转氨酶升高、肝肿大、黄疸、胆汁淤积、慢性肝炎伴纤维化、肝硬化、暴发性肝衰竭或肝脏肿瘤等各种病理变化。停药后,多数肝脏损害是可逆的。常见的具有肝毒性单味药有黄药子、苍耳子、雷公藤、麻黄、苦楝子、番泻叶等;常见的肝毒性复方制剂有壮骨关节丸、疳积散、复方青黛丸、克银丸、小柴胡汤等。中药配伍及中西药联合用药均可导致肝毒性的发生;中药的药性与肝毒性也有关;引起肝毒性的原因除与中药本身的毒性有关外,与医者用药剂量和用药时间及与患者本身体质也有关,季节、地域等因素也是引起肝毒性的重要原因。只有在中医药理论指导下,辨证施治,提高医术,合理用药,才是防止中药及复方制剂引起肝毒性的有效措施。     

Risk Factors of Hepatotoxicity During Anti-tuberculosis Treatment

Background

Antituberculosis treatment (ATT) induced hepato-toxicity is common, but risk factors predicting its development are poorly understood. The present study evaluates the clinical risk factors predicting the development of hepatotoxicity in Indian patients with tuberculosis on antituberculosis treatment.

Methods

Three groups of patients were studied at three service hospitals over a 3 year period from 2000-2002. Patients given ATT were followed up with monthly LFTs. Consecutive patients who developed Liver dysfunction (rise in SGPT > 5 times upper limit of normal) were studied, along with matched controls who did not. Markers for hepatitis B were also noted in these patients once in 6 months. A third group of patients who did not receive ATT but were HBsAg positive, were also similarly followed up. The possible association of age and sex of the patient, alcoholism, unrecognized chronic liver disease, hepatitis B virus carrier status and nutritional status with ATT-induced hepatitis was assessed. Statistical analysis was carried out by Chi square test/Fisher''s exact test using WHO provided software Epi Info 6. Sixty-nine patients with ATT-induced hepatotoxicity were prospectively studied. In addition 128 patients on anti-tuberculosis drugs without hepatotoxicity and 39 HBsAg carriers not on ATT were followed up for 1 year.

Results

Age, Sex, history of alcohol intake and BMI were not found to be related to development of hepatotoxicity. Presence of HBV infection or an underlying silent chronic liver disease were found to significantly increase the risk of development of ATT-induced hepatotoxicity. Continuation of ATT after development of jaundice was associated with a high fatality rate. It was possible to re-introduce isoniazid in 96% and rifampicin in 88% of patients with ATT induced hepatotoxicity.

Conclusion

ATT-induced hepatitis is common and is potentially fatal. It is likely to occur in those with underlying silent chronic liver disease, HBV infection and have been given ATT without a definite evidence of tuberculosis. Discontinuation of ATT leads to rapid recovery in most cases and drugs can safely be introduced after recovery in a majority of cases.Key Words: Antituberculosis treatment, hepatotoxicity, malnutrition     

凯西莱防治化疗药物性肝损害临床观察

目的：观察凯西莱（硫普罗宁）在恶性肿瘤患者接受化疗药时对化疗性肝损害的预防和治疗作用。方法：将154例患恶性肿瘤的患者分为两组,预防组78例,在化疗同时加用凯西莱,对照组76例单纯化疗,对出现肝损害的患者（28例）加用凯西莱治疗。结果：预防组肝损害的发生率明显低于对照组,有显著性差异（P〈0．01）;对照组中有肝损害的患者加用凯西莱治疗后肝功能指标有明显改善,有显著性差异（P〈0．01）。结论：凯西莱对恶性肿瘤患者伦疗性肝损害的预防和治疗疗效显著,值得,临床推广.     

化学品(药品)肝毒性的体外筛选试验

肝毒性是制约化学品(药品)开发、生产和应用的重要原因，而目前尚缺乏完善的肝毒性预测系统。动物实验数据用于人类是有限的，体外实验是对体内肝毒性预测系统很好的完善和补充。目前已用于肝毒性检测的方法为：肝细胞毒筛选实验；基因突变检测；共价结合分析；毒理基因组学和蛋白基因组学分析。利用分子生物学检测方法来改进和完善现行新药毒性检测手段，是本研究领域的发展方向和必然。