伊马替尼致肝毒性的文献分析OA

AIM To explore the occurrence and clinical characteristics of hepatotoxicity induced by imatinib through a literature case analysis,providing references for safe and rational drug use in clinical practice.METHODS Case reports on hepatotoxicity induced by imatinib were retrieved from Chinese databases,including CNKI,Wanfang,VIP,as well as international databases such as PubMed and Web of Science,covering the period from May 1,2001 to September 21,2024.Clinical data from relevant cases were collected and analyzed to statistically assess the incidence,clinical characteristics,management strategies,and outcomes of hepatotoxicity induced by imatinib.RESULTS A total of 30 relevant articles were retrieved,involving 33 patients.Among them,15 patients were males and 18 patients were females,with an average age of(50.88±14.41)years,ranging from 17 to 87 years.Of these patients,26 were treated with imatinib monotherapy,6 with combination therapy,and 1 with the combination of a ginseng-containing beverage.Before administering imatinib,31 patients showed normal liver function,a patient did not report liver function status,and a patient had mildly elevated bilirubin levels.The time from medication to the onset of hepatotoxicity ranged from 10 days to 18.5 months,with the majority(84.85％)occurring within 6 months.The clinical manifestations of hepatotoxicity primarily included jaundice,fatigue,nausea,and vomiting.Liver biopsies were performed in 15 patients,with results indicating drug-related liver injury.The classification of liver injury included 13 patients of hepatocellular injury type,5 patients of cholestatic type,and 4 patients of mixed type.Hepatotoxicity in 9 patients manifested as hepatitis B virus reactivation.Following the occurrence of hepatotoxicity,32 patients discontinued the medication,while a patient continued treatment.After discontinuation of imatinib,liver function mostly returned to normal within 14 days to 5 months,with 26 patients recovering/improving,6 patients dying,and a patient not mentioned.After the occurrence of hepatotoxicity,19 patients did not use imatinib again.Among the 13 patients resumed imatinib after discontinuation,6 patients experienced hepatotoxicity again.CONCLUSION Reports of hepatotoxicity induced by imatinib are rare.The clinical manifestations of liver toxicity primarily include jaundice,fatigue,nausea,and vomiting,while the exact mechanism remains unclear.Regular monitoring of liver function is recommended during imatinib use,and prompt discontinuation and appropriate treatment measures should be taken in patients with hepatotoxicity induced by imatinib.