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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。
Objective To improve the understanding of children’s DILI by studying the clinical features and prognosis of pediatric drug-induced liver injury (DILI). Methods A total of 184 DILI children aged <16 years who were hospitalized at the 302 Hospital of PLA from January 2004 to January 2014 were collected retrospectively. The clinical and pathological data were retrospectively analyzed. Results DILI may occur in children of all ages, and can be seen in infants and young children, a minimum of 2 months of age. 143 cases of clinically symptomatic (77.7%), mainly manifested as loss of appetite, eye yellow, urine yellow and so on. Drugs that cause liver damage include: traditional Chinese medicine (28.3%), antibacterial drugs (24.5%), antipyretic and analgesic drugs (19.6%) and so on. The main pathological features of DILI in children were eosinophil-predominant inflammatory cell infiltration (78.7%), mixed hepatic steatosis (73.5%), and cholestatic cholestasis (38.7%). During the course of the disease, 4 (2.2%) children were converted to autoimmune hepatitis and 29 (15.8%) children developed liver failure, of which 3 died of liver failure. After treatment, 177 cases (96.2%) of children with normal liver function returned to hospital. Conclusion Children DILI can be seen in all age groups, the main drug to cause the disease with traditional Chinese medicine, anti-bacterial drugs, antipyretic analgesics. Liver pathological examination is an important basis for the diagnosis of children with DILI. Although most children have a better prognosis, they should also be alert to the occurrence of liver failure and pay attention to regular follow-up.