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研究生:張菁文
研究生(外文):Ching-Wen Chang
論文名稱:藥物引起肝臟傷害
論文名稱(外文):Drug-induced Liver Injury
指導教授:張定宗張定宗引用關係高雅慧高雅慧引用關係
指導教授(外文):Ting-Tsung ChangYea Huei Kao Yang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:臨床藥學研究所
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:127
中文關鍵詞:藥物引起肝臟傷害
外文關鍵詞:Drug-induced liver injury
相關次數:
  • 被引用被引用:4
  • 點閱點閱:763
  • 評分評分:
  • 下載下載:169
  • 收藏至我的研究室書目清單書目收藏:1
  因為肝臟是人體代謝中樞,幾乎所有的藥物或化學物質都會經由肝臟生物轉換後排泄出人體,在生物轉換過程中有可能造成肝臟傷害;根據文獻報告約有2-5%黃疸病患是因藥物引起,肝炎住院病患中10%也是因藥物造成的,猛暴性肝炎更高達25%。這些數據顯示在藥物種類急遽增加的今日,藥物引起肝臟傷害的重要性也與日俱增。
  藥物引起肝臟傷害的臨床特徵表現是多變化的,藥物引起肝臟傷害的範圍可以類似包括所有急慢性肝臟疾病;因為藥物引起肝臟傷害的臨床表徵類似急慢性肝臟疾病,所以判斷藥物引起肝臟傷害只能依據臨床上的特徵,使得藥物引起肝臟傷害的診斷也較為困難,且因為醫護人員對藥物引起肝臟傷害的警覺性較低,所以造成藥物引起肝臟傷害有可能診斷率較低。
  本研究藥物引起肝臟傷害的文獻回顧以藥物引起肝臟傷害之機轉、臨床表徵及病理學型態變化的資料整理,藉由這些得以進一步幫助判斷臨床上常見藥物引起肝臟傷害的類型、處置及預防;也藉由文獻回顧藥物引起肝臟傷害不良反應評估表,以提供臨床評估藥物引起肝臟傷害的依據。
Chemical agents that can produce hepatic injury may be found in nature or be products of the chemical or pharmaceutical industry.
It is generally well appreciated that virtually all drugs, no matter what organ and tissue is being affected, exert some effects that are irrelevant. A wide variety of drugs, of almost every chemical structure, are subject to metabolic detoxification by the liver. The liver becomes far more vulnerable to the irrelevancies than does almost any other organ or tissue.
Drug-induced liver injury appears to account for 2% to 5% of hospitalized cases of jaundice, for about 10% of cases of hepatitis among all adult patients, and for up to 25% of cases of fulminant hepatic failure. The toxic effects of drugs on the liver have remained ignored; data suggest that adverse reactions to drugs are responsible for a greater proportion of cases of hepatic disease than previously appreciated.
Drug-induced liver injury is a multifaceted phenomenon; the spectrum of drug-induced hepatotoxicity can mimic all other of acute and chronic liver diseases.
Establishing the diagnosis of a drug-induced liver injury is often difficult because the diagnosis is based mainly on circumstantial evidence. It is important to know more about the mechanisms of hepatotoxicity, the clinical and morphologic pattern of drug-induced liver injury, it may help to evaluate drug-induced liver injury of a given case.
This review describes the main mechanisms involved in the causes of drug-induced liver injury, outlines the most common types of injury, and discusses diagnosis, management and prevention of drug-induced liver injury.
中文摘要 I
Abstract II
誌謝 IV
目錄 V
表目錄 VIII
圖目錄 XI
第壹章 前言 1
第一節 緒論 1
第二節 流行病學 5
第貳章 藥物代謝 9
第一節 Phase I反應 11
第二節 Phase II反應 19
第三節 活性代謝物 20
第四節 影響藥物代謝因子 23
第一項 基因因子 23
第二項 生理因子 27
第三項 環境因子 32
第參章 藥物引起的肝臟傷害 34
第一節 機轉(Mechanism) 36
第一項 內生性肝臟毒性 36
第二項 特異性肝臟傷害 37
第二節 型態學(Morphology) 44
第一項 急性肝臟傷害 44
第二項 慢性肝臟傷害 51
第三節 診斷 54
第一項 時間相關性 Chronological criteria 55

第二項 臨床標準Clinical criteria 58
第四節 藥物引起肝臟不良反應評估表 59
第五節 預防及處理 63
第肆章 藥物個論 65
第一節 非固醇類抗發炎藥物 65
第二節 抗癲癇藥物 77
第三節 抗生素 83
第四節 麻醉藥物 91
第五節 中草藥 96
第伍章 討論與建議 100
參考文獻 104
附錄 116
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