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目的 基于文献分析，探讨伊马替尼导致肝毒性的发生情况和临床特征，为临床安全、合理地使用伊马替尼提供参考。方法 检索中国知网、万方数据库、维普数据库、PubMed和Web of Science等国内外数据库中关于伊马替尼致肝毒性的病例个案报道，检索时限为2001年5月1日至2024年9月21日。收集病例的相关资料，对伊马替尼导致肝毒性的发生情况、临床特征、处理措施和转归情况进行统计和分析。结果 检索和筛选后，共纳入30篇相关文献，涉及33例病例，其中男性15例，女性18例，年龄（50.88±14.41）岁，17～87岁。其中26例为伊马替尼单药治疗，6例为联合用药，1例为联合使用含人参的饮料。使用伊马替尼前有31例病例肝功能正常，1例未提及肝功能情况，1例胆红素轻度异常。发生肝毒性的时间为用药后10 d至18.5个月，多集中在用药后6个月内（占84.85%）。肝毒性临床表现主要为黄疸、乏力、恶心、呕吐等。有15例病例进行了肝脏活检，结果提示为药物相关性肝损伤。在肝损伤类型方面，肝细胞损伤型的有13例，胆汁淤积型的有5例，混合型的有4例，乙肝病毒再激活引起的肝毒性损伤有9例。发生肝毒性后，32例病例予以停药，1例未停药。停药后，75.76%病例的肝功能在14 d至5个月内恢复正常。临床转归方面，26例病例痊愈/好转，6例死亡，1例不详。停药后，19例病例未再使用伊马替尼，13例在肝功能恢复正常后复用伊马替尼，其中6例再次出现了肝毒性。结论 伊马替尼导致的肝毒性报道较少，临床表现主要为黄疸、乏力、恶心、呕吐等，其作用机制尚不明确，建议在使用伊马替尼期间定期监测肝功能，出现伊马替尼导致的肝毒性时应及时停药并采取相应的治疗措施。
Abstract：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.
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基本信息:
DOI：10.19577/j.1007-4406.2026.01.011
中图分类号:R979.1
引用信息:
[1]邱刚,张春娟,周昔程.伊马替尼致肝毒性的文献分析[J].中国临床药学杂志,2026,35(01):64-69.DOI:10.19577/j.1007-4406.2026.01.011.
2026-01-25
2026-01-25