他汀类药物诱发的药物性肝损伤患者临床特点分析

摘要/Abstract

摘要： 目的他汀类药物诱发的药物性肝损伤(SILI)患者临床特点分析。方法选择2022年1月～2024年12月在本院接受诊治的SILI患者78例,根据临床预后情况分为好转组、未愈组,比较两组临床资料并分析预后影响因素。结果 78例SILI患者使用的他汀类药物包括阿托伐他汀、瑞舒伐他汀、辛伐他汀,以阿托伐他汀使用例数最多;药物使用至肝损伤时间90 d(70~122 d),住院时间10 d(5~18 d),合并HBV感染13例(16.7%),存在CYP450酶系基因变异11例(14.4%)。78例SILI患者好转53例、未愈25例,好转组和未愈组年龄、他汀类药物使用剂量、药物使用至肝损伤时间、住院时间、合并HBV感染、CYP450酶系基因变异,以及ALT、AST及TBil比较差异具有统计学意义(P<0.05)。年龄、药物使用剂量、合并HBV感染及CYP450酶系基因变异是影响SILI患者临床预后的独立危险因素(P<0.05)。结论应用他汀类药物前应仔细询问患者有无基础肝病史,在治疗过程中,对于年龄偏大、药物使用剂量预计较大等病例需要重视肝损伤的发生,需在用药期间尤其是用药后定期监测肝功能,以减少不良反应的发生。

关键词: 药物性肝损伤, 他汀类药物, 阿托伐他汀

Abstract: Objective To analyze the clinical characteristics of patients with statin-induced drug-induced liver injury (SILI). Methods A total of 78 patients with SILI treated in our hospital from January 2022 to December 2024 were enrolled and divided into improved and unimproved groups based on clinical outcomes. The clinical data and prognostic factors were compared between the two groups. Results Among the 78 SILI patients, the statins used included atorvastatin, rosuvastatin, and simvastatin, with atorvastatin being the most frequently prescribed. The median time from drug initiation to liver injury onset was 90 (70, 122) days, and the median hospitalization duration was 10 (5, 18) days. Concurrent HBV infection was present in 13 cases (16.7%), and CYP450 enzyme gene variations were detected in 11 cases (14.4%). Among the 78 SILI patients, 53 showed improvement, while 25 did not. Significant differences (P<0.05) were observed between the improved and unimproved groups in age, statin dosage, time to liver injury onset, hospitalization duration, HBV coinfection, CYP450 gene variations, and levels of ALT, AST, and TBil. Age, statin dosage, HBV coinfection, and CYP450 gene variations were identified as independent risk factors affecting clinical prognosis (P<0.05). Conclusion Before prescribing statins, clinicians should thoroughly assess patients for pre-existing liver disease. During treatment, special attention should be paid to elderly patients and those receiving higher doses to minimize the risk of liver injury. Regular liver function monitoring, particularly after drug initiation, is essential to reduce adverse reactions.

Key words: Drug-induced liver injury, Statins, Atorvastatin

徐燕, 庞轩. 他汀类药物诱发的药物性肝损伤患者临床特点分析[J]. 肝脏, 2025, 30(7): 972-974.

XU Yan, PANG Xuan. Analysis of clinical characteristics in patients with statin-induced drug-induced liver injury[J]. Chinese Hepatolgy, 2025, 30(7): 972-974.

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