儿童急性白血病化疗药物性肝损害的临床分析

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儿童急性白血病化疗药物性肝损害的临床分析

【摘要】目的探讨儿童急性白血病化疗药物性肝损害的临床特点。方法回顾性分析2007年1月至2008年12月间在本院儿科血液区住院的50例儿童急性白血病药物性肝损害患者的相关特点。结果全部病例均为急性肝损害，发生在用药后2~21 d。临床分型：肝细胞型29例；混合型12例；胆汁淤积型9例。引起肝损害的药物：MTX相关23例(46%)，MTX与6MP合用所致15例(30%)，L-ASP引起者5例(10%)，Ara-c引起1例(2%)，多药物综合作用6例(12%)。治疗及转归：停药或减量用药；并给予保肝、降酶、退黄治疗，本组患者均治愈。结论儿童急性白血病化疗药物性肝损害以急性肝损害常见，肝损害临床表现各异，与药物有关。早期发现及停药是治疗药物性肝损害的关键。

【Abstract】 Objective The purpose of this study is to probe the clinical characteristics of drug-induced liver disease（DILI） in children with acute leukemia（AL）．Methods Retrospective analysis the clinical feature of 50 children of DILI.All of them were diagnosed and treated as AL in our department during Jan 2007 to Nov 2008.Results All the 50 cases were acute hepatic injury,and the time of injury happened on 2~21 days after chemotherapy.Clinical typing:29 cases were mainly manifested as hepatic type，9 as cholestatic type and 12 as mixed type．Related @http://wendang.chazidian.comdrugs:23 cases(46%) were associated wjith methotrexate，15cases(30%) were associated with both methotrexate and etoposide，5 cases (10%)were associated with L-asparaginase，1 case (2%)was associated witharacytidine,and 6 cases (12%)were muitidrug complex action.Conclusion Acute injury is more common than chronic one in chidren with AL during chemotherepy．The clinical manifestations of liver injury are diferent，and are closely associated with different drugs．Early detection and stopping use of related drugs are essential for treatment．

【Key words】 Drug-induced liver disease; Chemotherapy; Leukemia; Children

据世界卫生组织统计，药源性肝损害(drug-induced liver disease，DILD)已上升为全球死亡原因的第五位。儿童急性白血病治疗过程中肝功能损伤的发生率高，有时甚至发生致死性肝损害。积极治疗儿童急性白血病药物性肝损害，尽快改善肝功能是化疗成功的重要一环。现将我科2007年1月至2008年12月期间化疗的50例不伴肝胆疾病的药物性肝损害儿童急性白血病患者的临床资料进行回顾性分析如下。

1 资料与方法

1.1 一般资料 2007年1月至2008年12月在本院儿科血液区住院的儿童急性白血病药物性肝损害患者50例，均按照Maria药物性肝损害的诊断标准（1997年）［1］。年龄1~14岁，其中男34例，女16例；急性淋巴细胞白血病35例，急性粒细胞白血病15例。所选病例化疗前肝功均正常。

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