摘要
目的:了解喹诺酮类药物致肝毒性发生的特点和规律,为临床安全用药提供参考。方法:以"喹诺酮""沙星""肝毒性""肝损害""Hepatotoxicity"等为检索词,系统检索中国知网、万方、维普、PubMed等国内外数据库(检索时间均为各数据库建库起至2017年12月31日)收录的喹诺酮类药物致肝毒性个案报道的相关文献,并进行汇总与分析。结果:共收集有效文献59篇,获取喹诺酮类药物致肝毒性病例61例,涉及环丙沙星、莫西沙星、氧氟沙星、洛美沙星、诺氟沙星、左氧氟沙星、加替沙星、依诺沙星等8个品种。其中,环丙沙星、左氧氟沙星、莫西沙星、氧氟沙星致肝毒性较多,分别为19、13、11、7例次,累积构成比达81.97%。男、女性患者比例为1.54∶1,以61～80岁患者居多(共30例,占49.18%)。原患疾病为单一病种的有46例(占75.41%),以呼吸系统、泌尿生殖系统感染为主;合并其他疾病的有15例(占24.59%)。单独应用喹诺酮类药物的有31例,以环丙沙星的最多;联合用药的有30例。静脉给药的有34例,以国内病例为主。肝毒性最早出现在用药后10 min内,最晚出现用药8周后;有49例患者在用药后10 d内出现肝毒性,占80.33%。临床症状除全身乏力、恶心呕吐等外,还包括丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素等指标的异常升高。54例患者经停药或对症处理后好转,7例患者死亡。药物性肝损伤因果关系评价结果显示,极可能有关的有4例,很可能有关的有45例,可能有关的有12例。结论:喹诺酮类药物致肝毒性与药物品种、患者年龄、原患疾病、联合用药、给药途径等有关,且多发生在用药后10 d内。临床应密切关注患者的肝功能指标,加强用药监护,谨慎联合用药。
OBJECTIVE:To investigate the characteristics and regularity of hepatotoxicity induced by quinolones,and to provide reference for clinical use of drug safely.METHODS:Using“quinolone”“floxacin”“hepatotoxicity”“hepatic injury”as retrieval words,relevant literatures about hepatotoxicity induced by quinolones were retrieved from domestic and foreign databases as CNKI,Wanfang,VIP,PubMed(during database establishment to 31th,Dec.2017).Those literatures were summarized and analyzed.RESULTS:A total of 59 valid literatures were collected,including 61 cases of hepatotoxicity induced by quinolones,8 types of drugs as ciprofloxacin,moxifloxacin,ofloxacin,lomefloxacin,norfloxacin,levofloxacin,gatifloxacin and enoxacin.Ciprofloxacin,levofloxacin,moxifloxacin and ofloxacin were the most common drugs that caused hepatotoxicity,involving 19,13,11,7 cases,respectively;accumulative constitute ratio was 81.97%.The ratio of male to female was 1.54∶1,and hepatotoxicity always happened at the age of 61 to 80(30 cases,49.18%).Primary diseases of 46 cases were single disease(75.41%),and mainly were infection of respiratory system and urogenital system.There were 15 cases of combined disease(24.59%).Thirty-one cases used quinolones alone,most of which was ciprofloxacin.There were 30 cases of drug combination.Thirty-four cases were given drug intravenously and mainly were domestic cases.The hepatotoxicity first occurred within 10 minutes after administration and at the latest 8 weeks after administration.Forty-nine patients suffered from hepatotoxicity within 10 days after medication,accounting for 80.33%.Besides general fatigue,nausea and vomiting,clinical symptoms also included abnormal elevation of alanine aminotransferase,aspartate aminotransferase and total bilirubin,etc.Fifty-four patients were improved after withdrawal or symptomatic treatment,while 7 patients died.The results of causality evaluation of drug-induced hepatic injury showed that there were 4 probably association cases,45 likely association cases and 12
作者
杨金兰
王升
胡伟
刘如品
师少军
张玉
伍三兰
YANG Jinlan;WANG Sheng;HU Wei;LIU Rupin;SHI Shaojun;ZHANG Yu;WU Sanlan(Dept. of Pharmacy,Xinyang Central Hospital,Henan Xinyang 464000,China;Dept. of Pharmacy,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《中国药房》
CAS
北大核心
2019年第2期244-249,共6页
China Pharmacy
基金
国家自然科学基金资助项目(No.71403091)
关键词
喹诺酮类药物
肝毒性
特点
文献分析
Quinolones
Hepatotoxicity
Characteristics
Literature analysis
