慢性药物性肝损伤患者临床特征及转归分析

摘要/Abstract

摘要： 目的分析慢性药物性肝损伤(DILI)患者临床特征,探讨这些临床特征对疾病转归的影响。方法选取我院2018年3月—2021年3月慢性DILI患者340例,统计导致慢性DILI发生的药物种类。于患者治疗结束后(6个月)分为预后不良组(n=102)和预后良好组(n=238),对比两组基础信息、临床病理资料及肝生化相关指标。取ALT、AST、Alb、TBil、DBil中位值作为截断值,进行logistic回归分析危险因素。结果 340例患者中,引起慢性DILI的药物有十几种,其中中药占31.18%,解热镇痛药占12.35%,抗肿瘤类占11.76%,抗生素类占9.41%,其次为激素类、心血管类、保健品类等。预后不良组年龄≥60岁,胆汁淤积型或混合型患者占57.84%、63.74%,显著高于预后良好组的41.60%、37.82%;预后不良组ALT、AST、ALP、TBil、DBil、GGT水平分别为(524.58 ± 89.53)U/L、(408.45 ± 89.56)U/L、(192.42 ± 78.45)U/L、(43.25 ± 12.64)μmol/L、(32.58 ± 12.41)μmol/L、(148.52 ± 51.44)U/L,预后良好组分别为(329.75 ± 87.55)U/L、(272.41 ± 78.48)U/L、(176.52 ± 69.86)U/L、(32.15 ± 14.15)μmol/L、(28.47 ± 8.97)μmol/L、(139.45 ± 42.52)U/L,预后不良组ALT、AST、TBil、DBil水平显著高于预后良好组。预后不良组Alb水平为(45.15 ± 15.42)g/L,显著低于预后良好组的(59.86 ± 17.45)g/L(P<0.05)。logistic分析发现,年龄≥60岁、非肝细胞型、ALT≥435.40 U/L、AST≥325.24 U/L、Alb≤52.15 g/L、TBil≥38.53 μmol/L、DBil≥29.14 μmol/L是慢性DILI预后不良的危险因素。结论导致慢性DILI的药物较多,年龄、肝损伤类型及肝生化指标与慢性DILI患者转归具有较大关系,采用易引起慢性DILI的药物治疗时需要密切监控患者肝生化指标,并及时进行干预,控制DILI的发生和发展。

关键词: 药物性肝损伤, 临床特征, 转归, 肝生化指标

Abstract: Objective To analyze the clinical characteristics of patients with chronic drug-induced liver injury (DILI) and to explore the impact of these clinical characteristics on the outcome of the disease.Methods 340 cases of chronic DILI patients from March 2018 to March 2021 in our hospital were selected. After treatment for 6 months, the patients were divided into poor prognosis group (n=102) and good prognosis group (n=38). The basic data, clinicopathological data and related indexes of liver function were compared between the two groups. The median values of ALT, AST, Alb, TBil and DBil were taken as the cut-off values, and the risk factors were analyzed by logistic regression.Results In 340 patients, there were more than a dozen different kinds of drugs causing chronic DILI, among which traditional Chinese medicine accounted for 31.18%, antipyretic and analgesic drugs accounted for 12.35%, antitumor drugs accounted for 11.76%, antibiotics accounted for 9.41%, followed by hormones, cardiovascular medication, health care products. In the poor prognosis group, age ≥ 60 years old, and the proportions of patients with cholestasis or mixed type were 57.84% and 63.74%, which were significantly higher than 41.60% and 37.82% in the good prognosis group. The levels of ALT, AST, ALP, TBil, DBil and GGT in the poor prognosis group were (524.58 ± 89.53) U/L, (408.45 ± 89.56) U/L, (192.42 ± 78.45) U/L, (43.25 ± 12.64) μmol/L, (32.58 ± 12.41) μmol/L, (148.52 ± 51.44) U/L, which in the good prognosis group were (329.75 ± 87.55) U/L, (272.41 ± 78.48) U/L, (176.52 ± 69.86) U/L, (32.15 ± 14.15) μmol/L, (28.47 ± 8.97) μmol/L, (139.45 ± 42.52) U/L, respectively. The levels of ALT, AST, TBil and DBil in the poor prognosis group were significantly higher than those in the good prognosis group. Alb level was (45.15 ± 15.42) g/L in the poor prognosis group, which was significantly lower than that in the good prognosis group (59.86 ± 17.45) g/L (P<0.05). Logistic analysis showed that Age ≥ 60 years, non-hepatocellular type, ALT≥435.40 U/L, AST≥325.24 U/L, Alb≤52.15 g/L, TBil≥38.53 μmol/L, DBil≥29.14 μmol/L were risk factors for poor prognosis of chronic DILI.Conclusion There are many drugs causing chronic DILI, and age, types of liver injury and liver biochemical indexes have a great relationship with the outcome of patients with chronic DILI. Patients’ liver function indexes should be closely monitored and intervention in time should be carried out to control the occurrence and development of DILI while using drugs prone to cause chronic DILI.

Key words: Drug-induced liver injury, Clinical features, Outcome, Liver biochemical index

陈红, 赵莎莎, 杨婉君. 慢性药物性肝损伤患者临床特征及转归分析[J]. 肝脏, 2022, 27(6): 679-682.

CHEN Hong, ZHAO Sha-sha, YANG Wan-jun. Clinical characteristics and outcome of patients with chronic drug-induced liver injury[J]. Chinese Hepatolgy, 2022, 27(6): 679-682.

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