布鲁氏菌病住院患者中药物性肝损伤的患病率、临床特征以及危险因素分析

摘要/Abstract

摘要： 目的调查布鲁氏菌病住院患者治疗期间与药物性肝损伤(DILI)相关的患病率、人口统计学和临床特征以及危险因素。方法选取2019年6月至2024年6月间入院的432例布鲁氏菌病住院患者临床资料。统计布鲁氏菌病流行病信息、临床表现;依据是否合并DILI分为合并DILI组、未合并DILI组,比较两组临床资料并作多因素logistic回归分析,探讨布鲁氏菌病患者DILI发生的独立危险因素。结果 432例布鲁氏菌病患者年龄为18～76岁,其中50～64岁患者占比最高,占42.1%(182/432);全年均有病例发生,以夏季病例最多,占44.7%(193/432);54.4%(235/432)患者为养殖业从业者;72.7%(314/432)有明确的动物接触经历。临床表现以发热最为常见,占82.2%(355/432),体温范围37.5℃～41.9℃,多见于下午和夜间;其余常见临床表现包括寒战41.0%(177/432)、腰痛35.2%(152/432)、盗汗21.7%(94/432)、关节痛17.1%(74/432)。布鲁氏菌病患者中DILI患病率为14.6%(63/432)。治疗前后合并、未合并DILI组CRP及PCT比较差异具有统计学意义(P<0.05)。与治疗前比,治疗后合并DILI组WBC、CRP、ESR及PCT显著降低(P<0.05)。与未合并DILI组比,治疗前合并DILI组ALT、AST及LDL明显升高(P<0.05);与治疗前比,治疗后合并DILI组ALT、AST及LDL显著降低(P<0.05),而与未合并DILI组比较差异不具有统计学意义(P>0.05)。以布鲁氏菌病患者是否合并DILI(未合并=0,合并=1)为因变量,以未合并、合并DILI存在差异性指标作为自变量,对CRP、PCT、ALT、AST及LDL赋值(实测值)并进行多因素logistic回归分析,结果显示CRP、PCT及LDL是影响布鲁氏菌病患者DILI发生的独立危险因素(P<0.05)。结论布鲁氏菌病患者中合并存在DILI的比例不低,CRP、PCT及LDL是预测布鲁氏菌病患者DILI发生的重要因素。

关键词: 布鲁氏菌病, 药物性肝损伤, 临床特征, 危险因素

Abstract: Objective To investigate the prevalence, demographic and clinical characteristics and risk factors related to drug-induced liver injury (DILI) in hospitalized patients with brucellosis during treatment. Methods The clinical data of 432 hospitalized patients with brucellosis between June 2019 and June 2024 were selected. Statistics of epidemic information and clinical manifestations of brucellosis; According the occurrence of DILI, the patients were divided into two groups: DILI group and non-DILI group. The clinical data of the two groups were compared and multivariate logistic regression analysis was exerted to explore the independent risk factors of DILI in brucellosis patients. Results Among the 432 cases of brucellosis, the age ranged from 18 to 76 years old, with 50 to 64 years old accounting for 42.1% (182/432). Cases occurred all year round, with summer cases accounting for 44.7% (193/432). 54.4% (235/432) patients were engaged in aquaculture; 72.7% (314/432) had definite animal contact experience. Fever is the most common symptom, accounting for 82.2% (355/432), and the temperature ranges from 37.5℃ to 41.9℃, which is more common in the afternoon and night. Other common clinical manifestations include chills 41.0% (177/432), low back pain 35.2% (152/432), night sweats 21.7% (94/432) and joint pain 17.1% (74/432). The prevalence rate of DILI in brucellosis patients was 14.6% (63/432). There were statistically significant differences in CRP and PCT between patients with and without DILI before and after treatment (P<0.05). Compared with the DILI group before treatment, WBC, CRP, ESR and PCT decreased significantly after treatment (P<0.05). Compared with non-DILI group, ALT, AST and LDL in the DILI group increased significantly before treatment (P<0.05). Compared with the non-DILI group before treatment, ALT, AST and LDL decreased significantly after treatment (P<0.05), but there was no significant difference compared with non-DILI group before treatment (P>0.05). Using DILI occurrence (unincorporated=0, combined=1) in brucellosis patients as the dependent variable, and the indicators of differences between unincorporated and combined DILI as the independent variable, CRP, PCT, ALT, AST and LDL were assigned (measured values) and multivariate logistic regression analysis was conducted. The results showed that CRP, PCT and LDL were independent risk factors for the occurrence of DILI in patients with brucellosis (P<0.05). Conclusion The proportion of patients with brucellosis complicated with DILI is common. CRP, PCT and LDL are important factors to predict the occurrence of DILI in patients with brucellosis.

Key words: Brucellosis, Drug-induced liver injury, Clinical features, Risk factors

陈文, 范军伟, 赵鹏. 布鲁氏菌病住院患者中药物性肝损伤的患病率、临床特征以及危险因素分析[J]. 肝脏, 2025, 30(8): 1129-1132.

CHEN Wen, FAN Jun-wei, ZHAO Peng. Prevalence, clinical characteristics and risk factors of drug-induced liver injury in hospitalized patients with brucellosis[J]. Chinese Hepatolgy, 2025, 30(8): 1129-1132.

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