阿奇霉素致药物性肝损伤临床误诊探析  

Clinical Misdiagnosis of Drug-induced Liver Injury by Azithromycin

作　　者：林赫妍 熊昊 LIN Heyan;XIONG Hao(Department of Critical Care Medicine,Hongsen Hospital,Harbin Medical University,Sanya,Hainan 572000,China)

机构地区：[1]三亚哈尔滨医科大学鸿森医院重症医学科,海南三亚572000

出　　处：《临床误诊误治》2024年第13期23-27,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨阿奇霉素致药物性肝损伤(DILI)的临床特点、误诊原因及防范措施。方法回顾分析2020年2月至2022年10月阿奇霉素致DILI误诊患者11例的临床病例资料。结果11例中男5例、女6例;年龄6~58岁。2例以发热、咳嗽、胸闷,初步诊断为肺炎收入院。1例以发热、关节酸痛,初步诊断为类风湿关节炎收入院。3例以皮肤瘙痒、皮疹,初步诊断为过敏性皮疹收入院。5例以食欲减退、乏力、恶心、上腹部不适,初步诊断为胃炎收入院。对应治疗后首诊症状未见好转,6例出现不同程度黄疸、肝区不适。11例行肝功能检查异常。肝脏超声显示:1例未见明显异常;8例肝脏轮廓正常,肝实质回声减低,呈细颗粒状,密度较稀疏;2例肝脏略增大,肝实质光点增亮、增粗,高回声,分布不均。追溯病史患者均有急性上呼吸道感染史及阿奇霉素服用史。遂确诊为阿奇霉素致DILI。误诊时间1~2 d。11例予以保肝、解毒、降酶对症治疗,首诊症状显著缓解,肝功能逐步恢复正常,复查肝脏超声肝脏受损程度明显改善,预后良好。结论DILI临床表现各异,且缺乏特异性,首发症状可以是多种肝外表现,易引起误诊。大部分患者停药后可恢复。因此临床医师应提高对DILI的诊断能力,临床药师应积极参与临床查房、药学会诊等,加强用药指导,减少DILI的发生。Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of drug-induced liver injury(DILI)by Azithromycin.Methods The clinical data of 11 patients with DILI by Azithromycin misdiagnosed from February 2020 to October 2022 were retrospectively analyzed.Results Among the 11 patients,5 were males and 6 were females,aged 6-58 years.Two patients were admitted to hospital with fever,cough and chest tightness,and were initially diagnosed as pneumonia.One patient was admitted to the hospital with fever and joint pain and was initially diagnosed as rheumatoid arthritis.Three patients were admitted to the hospital with skin pruritus and rash,which were initially diagnosed as allergic rash.Five patients were admitted to hospital with anorexia,fatigue,nausea and upper abdominal discomfort,and were initially diagnosed as gastritis.After corresponding treatment,the initial symptoms did not improve,and 6 patients showed different degrees of jaundice and liver discomfort.Abnormal liver function tests were performed in 11 patients.Liver ultrasound showed no obvious abnormality in 1 patient.In 8 patients,the liver contour was normal,the liver solid echo was reduced,and the density was sparse.In 2 patients,the liver was slightly enlarged,and the liver parenchymal spot was brightened and thickened,with high echo and uneven distribution.All patients had a history of acute upper respiratory tract infection and use of Azithromycin.They were diagnosed as DILI by Azithromycin.The misdiagnosis lasted 1-2 d.All 11 patients were treated with liver protection,detoxification and enzyme reduction.The initial symptoms were significantly relieved,the liver function gradually returned to normal,and the liver damage degree was significantly improved by ultrasound examination of the liver,with good prognosis.Conclusion The clinical manifestations of DILI are different and lack of specificity,and the initial symptoms can be a variety of extra-hepatic manifestations,which is more likely to cause misdiagnosis.Most

关 键 词：药物性肝损伤 阿奇霉素 误诊 肺炎 类风湿关节炎 过敏性皮疹 胃炎 肝功能 

分 类 号：R575.1[医药卫生—消化系统]