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54例抗结核药致儿童药物性肝损伤的临床特点及护理对策

作者：万彬曾义岚陈竹陈丽

单位：成都市公共卫生临床医疗中心成都 610066

关键词：肝损伤抗结核治疗儿童临床特点护理

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出版年,卷(期):页码：2016,8(2):34-38

摘要：

摘要：目的探讨抗结核药所致儿童药物性肝损伤（drug-induced liver injury，DILI）的临床特点，
并提出有效的护理对策。方法回顾性分析2010年1月至2014年12月本院收治的54例抗结核药物所
致DILI的结核病患儿的临床特点，总结护理措施。结果抗结核药物所致DILI的发生率为11.56%
（54/467），以血行播散型肺结核的DILI发生率最高（20%，14/70）。54例患儿中，肝细胞型DILI最
多见（48.15%，26/54），其次是胆汁淤积型（33.33%，18/54）及混合型（18.51%，10/54）；肝细
胞型DILI患儿的ALT水平最高（F = 6.993，P = 0.003），而胆汁淤积型DILI患儿的AST和TBil水平最
高（F = 3.884，P=0.031；F = 3.884，P = 0.001）。复治结核患儿与初治患儿相比，更易发生DILI，
且服药至发病的时间更长（124.29天 vs. 37.52天；t = -5.093，P = 0.000）。经治疗后，48例患儿治愈
或好转（88.89%，48/54），6例患儿因病情恶化自动出院。基础护理和专科护理相结合的护理措施有
助于早期发现DILI，提高依从性。结论临床医师应重视儿童抗结核治疗中不良反应的监测和综合护
理，积极防治DILI。

Abstract: Objective To investigate the clinical features and nursing measures of children with drug-induced
liver injury (DILI) caused by anti-tuberculosis (anti-TB) treatment. Methods Clinical features and nursing
measures of 54 children with DILI caused by anti-TB treatment from January 2010 to December 2014 in
Public Health Clinical Center of Chengdu were analyzed retrospectively and the nursing measures were
summarized. Results The incidence of DILI caused by anti-TB treatment was 11.56% (54/467), and in which
the hematogenous TB was the most (20%, 14/70). In the 54 cases, the most common type was hepatocellular
damage type (48.15%, 26/54), mixed type (33.33%, 18/54) and cholestasis type (18.51%,10/54) were
followed by. The levels of ALT in children with hepatocellular damage type of DILI were the highest and the
levels of AST and TBil in children with cholestasis type of DILI were the highest (F = 3.884, P = 0.031; F =
3.884, P = 0.001). Compared with primary TB group, the incidence of DILI in recurrent TB group was higher,
and the onset time was longer (124.29 d vs. 37.52 d; t = -5.093, P = 0.000). After treatment, 48 children were
cured or improved (88.89%, 48/54), while 6 children discharged because of deterioration. Basic nursing
combined with specialist nursing may help to detect DILI early and may improve the compliance. Conclusion
Clinicians should pay attention to adverse drug reaction monitoring and comprehensive nursing in order to
prevent and cure DILI actively.

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