24例甲巯咪唑致胆汁淤积性肝损伤文献分析

Literature Review of 24 Cases with Methimazole-induced Cholestatic Liver Injury

关键词:  胆汁淤积性肝损伤  甲巯咪唑  药源性肝炎  黄疸  文献分析

Key words:  cholestatic liver injury  methimazole  drug-induced hepatitis  icterus  literature review

摘要:

目的 分析甲巯咪唑致胆汁淤积性肝损伤发生特点与规律，为防治及临床安全用药提供参考。方法 检索国内外文献数据库中有关甲巯咪唑致胆汁淤积性肝损伤（黄疸）的个案报道，并进行计量学分析。结果 获8篇个案报道，共计24例患者，其中男性1例，女性23例；年龄48~58岁共8例，均为女性，占33.33%；其次为37~47岁共7例，均为女性，占29.17%。合并用药与甲巯咪唑单次给药相比，致胆汁淤积性肝损伤发生率未见差异（25.00% vs 25.00%，P>0.05）；诱导期以21~35 d为主，占比58.33%，其次为7~21 d，占比37.50%。药物与不良事件因果关系诺氏（Naranjo's）评分肯定4例（16.67%），很可能20例（83.33%）。结论 中年女性甲亢患者为甲巯咪唑致胆汁淤积性肝损伤的高危人群，宜对其进行中短期用药监护，权衡利弊，尽量避免和减少药源性胆汁淤积性肝损伤发生。

Abstract:

OBJECTIVE To analyze the characteristics and general patterns of cholestatic liver injury by methimazole and provide a reference for clinical use. METHODS To retrieve the cases of the patients with cholestatic liver injury (jaundice) by methimazole in domestic and foreign literature database and analyze the cases. RESULTS A total of 24 patients in eight cases were reported. Among the patients, there were 1 male and 23 females, and 8 female(33.33%) were 48-58 years old, 7 female(29.17%) were 37-47 years old. There was no difference between the treatment of single dose of methimazole and combination which induced cholestatic liver injury incidence rate (25.00% vs 25.00%, P>0.05). The induction period was mainly from 21 to 35 days(58.33%), followed by 7-21 days(37.50%). According to Naranjo's score, there were 4 cases (16.67%) of cholestatic liver injury certainly induced by methimazole, and 20 cases probably induced by methimazole. CONCLUSION Middle-aged women with hyperthyroidism are the high risk group of liver injury caused by methimazole. It should be monitored in the medium and short term, and avoid or reduce the occurrence of drug-induced cholestasis liver injury.