中国药物警戒 ›› 2019, Vol. 16 ›› Issue (5): 277-280.

• 药物相关肝损伤研究专栏 • 上一篇    下一篇

银屑病用药相关肝损伤分析

朱敬肖1,2, 葛斐林2, 刘亚蕾2, 张雅铭2, 王伽伯2, 郭玉明2,*, 肖小河2,*   

  1. 1 湖南中医药大学药学院,湖南 长沙 410208;
    2 解放军总医院第五医学中心/全军中医药研究所,北京 100039
  • 收稿日期:2019-03-18 修回日期:2019-06-11 出版日期:2019-05-20 发布日期:2019-06-11
  • 通讯作者: 郭玉明,女,博士,助理研究员,中医药临床评价。E-mail: guoyuming_0520@126.com; 肖小河,男,研究员·博导,中草药肝损伤与安全用药,中药质量生物评价。E-mail: pharmacy302xxh@126.com
  • 作者简介:朱敬肖,女,在读硕士,临床中药学。
  • 基金资助:
    国家自然科学基金重点项目（81630100）：基于临床病症的传统无毒中药肝毒性客观辨识及机制研究

Analysis of Drug-induced Liver Injury Related to Psoriasis Treatment

ZHU Jingxiao1,2, Ge Feilin1, LIU Yalei2, ZHANG Yaming2, WANG Jiabo2, GUO Yuming2,*, XIAO Xiaohe2,*   

  1. 1 College of Pharmacy, Hunan University of Chinese Medicine, Hunan Changsha 410208, China;
    2 China Military Institute of Chinese Medicine, the Fifth Medical Centre of Chinese People's Liberation Army General Hospital, Beijing 100039, China
  • Received:2019-03-18 Revised:2019-06-11 Online:2019-05-20 Published:2019-06-11

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摘要： 目的 分析银屑病用药相关肝损伤的人群特征和药物特征,为银屑病临床合理用药提供参考。方法 对2012年1月~2016年12月银屑病用药相关肝损伤的病例进行回顾性分析。结果 共收集到银屑病用药相关肝损伤病例 155例,其中男性101例,女性54例（男性：女性=1.87:1）;年龄范围为11~80岁,其中31~50岁年龄段占比为48.38%。120例（77.42%）患者用药史较为清晰,损肝药物单一,中药致肝损伤占32.5%,西药致肝损伤占67.5%;二者服药到肝损伤发生时间集中在30天内,中药服药到肝损伤发生的中位时间（16天）大于西药（10.5天）;导致肝损伤的药物主要为阿维A、甲氨蝶呤、雷公藤多苷片等,其中西药以阿维A（38.27%）和甲氨蝶呤（34.57%）为主,中药以雷公藤多苷片（28.30%）、克银丸（23.07%）、复方青黛胶囊（15.38%）为主;35例（22.58%）患者联用2种及以上损肝药物,联合用药致肝损伤的严重不良反应程度与单用具有显著性差异（P <0.05）,其中阿维A胶囊和雷公藤多苷片联用报告人次最多。结论 银屑病用药存在一定的肝损伤风险,在临床诊疗中应重点加强关注;中药致肝损伤潜伏期比西药略长,在服用银屑病治疗药物后应注意及时、尽早监测肝功能,并且警惕中西药联合用药的肝损伤风险。

关键词: 银屑病, 药物性肝损伤, 临床特征, 用药特点

Abstract: Objective To provide reference for rational medication of psoriasis by analyzing the demographic and drug characteristics of drug-induced liver injury for psoriasis treatment. Methods A retrospective study was performed in drug-induced liver injury cases associated with psoriasis between January 2012 and December 2016. Results A total of 155 DILI cases were collected, including 101 males and 54 females. The age range is 11 to 80 years and the age of 31~50 accounted for 48.38%. 120 cases(77.42%) of patients had clear history of medication, DILI caused by the traditional Chinese medicines(TCM) accounted for 32.5%, and DILI caused by western medicines accounted for 67.5%. The time span from taking drugs until liver injury occurred concentrated in 30 days. The median time of TCM (16 days) was longer than that of western medicines (10.5 days). Primary suspected western medicines were acitretin (38.27%) and methotrexate (34.57%). Suspected TCM mainly included tripterygium glycosides tablet(28.30%), Keyin pill(23.07%) and compound Qingdai capsule(15.38%). 35 cases (22.58%) of patients took two or more drugs, and the significant difference existed in the severity of adverse reactions caused by combined and single medication(P <0.05). The DILI reports about acitretin capsule and tripterygium glycosides tablet were with the largest number of people. Conclusion Drugs in treatment of psoriasis have a certain risk of liver injury, which should be paid close attention in clinical diagnosis and treatment. Latency period of liver injury caused by TCM is slightly longer than that of western medicines. After taking drugs related to psoriasis treatment, patients should monitor liver function timely and early, and be alert to the risk of liver injury caused by the combination of Chinese and western medicines.

Key words: psoriasis, drug-induced liver injury, clinical characteristics, medication features

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