目的 分析左甲狀腺素鈉引起患者肝損傷不良反應(yīng)（ADR）的特點(diǎn)，為臨床合理用藥提供參考。方法 檢索PubMed、Embase、Cochrane Library、中文學(xué)術(shù)期刊全文數(shù)據(jù)庫(kù)（CNKI）、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)（CBM）、萬(wàn)方數(shù)據(jù)庫(kù)（WanFang Data）、維普中文期刊全文數(shù)據(jù)庫(kù)（VIP）等關(guān)于左甲狀腺素致患者肝損傷的報(bào)道，從患者的基本狀況、原發(fā)疾病、服用劑量、肝損出現(xiàn)時(shí)間、肝損類型和伴隨癥狀、對(duì)策和預(yù)后等方面進(jìn)行分析。結(jié)果 共收集到文獻(xiàn)11篇，其中國(guó)內(nèi)報(bào)道2篇、國(guó)外報(bào)道9篇；共涉及患者11例，其中男性2例、女性9例，50～70歲患者占比較高（占54.55%）；除1例因先天垂體發(fā)育不全外，其余原發(fā)疾病為不同原因引起的甲狀腺功能減退；起始劑量多為25、50 μg/d（占72.73%），近半數(shù)患者（占45.46%）用藥過程中增加劑量；多數(shù)患者（占54.55%）肝損傷發(fā)生在用藥7～60 d；肝損傷類型中肝細(xì)胞損傷型、混合型、膽汁淤積型分別占36.37%、27.28%、18.19%，患者多伴有發(fā)熱、疲勞、厭食等癥狀；多數(shù)患者（占90.91%）在肝損傷發(fā)生后更換藥品，換藥后肝功能恢復(fù)正常。結(jié)論 使用左甲狀腺素鈉時(shí)應(yīng)加強(qiáng)用藥監(jiān)測(cè)，減少肝損傷ADR的發(fā)生。

Objectives To analyze the characteristics of liver injury adverse reactions (ADRs) caused by levothyroxine in patients, and to provide reference for rational clinical use. Methods Cases of liver injury caused by levothyroxine in patients were retrieved from PubMed, Embase, Cochrane Library, CNKI, CBM, WanFang Data, VIP and analyzed from the aspects of patients' basic condition, primary disease, dosage, time of liver injury, type and associated symptoms, countermeasures and prognosis. Results A total of 11 qualified documents were analyzed, including two domestic cases and nine foreign cases. A total of 11 patients were involved, including two males and nine females. The proportion of patients aged 50 — 70 years was relatively high (54.55%). Except for 1 case of congenital pituitary dysplasia, the primary diseases of other cases were hypothyroidism caused by different causes.Most of the initial dose was 25 or 50 μg/d (72.73%), and the dose of nearly half of the patients (45.46%) was increased.Most of the patients (54.55%) suffered liver damage within 7 to 60 days of administration. Among the liver lesion types, the liver cell injury type, the mixed type and the cholestasis type accounted for 36.37%, 27.28% and 18.19% respectively.Drugs of most of the patients (90.91%) were changed after liver damage, and the liver function returned to normal after dressing change. Conclusion When levothyroxine are used by patients, medication monitoring should be strengthened to reduce the occurrence of adverse reactions caused by liver damage.

中國(guó)藥學(xué)會(huì)全國(guó)醫(yī)藥經(jīng)濟(jì)信息網(wǎng)科技傳播創(chuàng)新工程［CMEI2021KPYJ（JZX）00104］，河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目（2018020663）