药物性肝损伤的临床特点及危险因素分析

林云霞; 何晓彬

doi:10.3969/j.issn.1001-5256.2018.06.021

药物性肝损伤的临床特点及危险因素分析

DOI: 10.3969/j.issn.1001-5256.2018.06.021

1. 西南医科大学临床医学院
2. 西南医科大学附属医院消化内科

详细信息

中图分类号: R575
计量
- 文章访问数: 2064
- HTML全文浏览量: 36
- PDF下载量: 401
- 被引次数: 0
出版历程
- 收稿日期: 2018-02-28
- 出版日期: 2018-06-20

Clinical features of drug-induced liver injury and related risk factors

Clinical Medical College, Southwest Medical University

摘要

摘要:
目的探讨药物性肝损伤（DILI）的临床特点及危险因素。方法回顾性分析2013年1月-2017年11月在西南医科大学附属医院诊断为DILI的208例患者的药物种类、临床资料和实验室检查,分析DILI的临床特点。其中使用抗结核药、肿瘤药、免疫制剂致DILI的患者80例作为观察组,另选取同期在该院使用该3种药物但未发生DILI的患者80例作为对照组,进行危险因素分析。正态分布的计量资料多组间比较采用方差分析;非正态分布计量资料多组间比较采用Kruskal-Wallis H检验。计数资料的无序变量组间比较采用χ2检验;等级变量采用Mann-Whitney U检验,logistic回归分析危险因素。结果以中药引起DILI的患者所占比例最大（30.8%）;不同类型DILI之间性别、ALT、AST、TBil、GGT、总胆汁酸（TBA）差异均有统计学意义（χ2=6.081,H值分别为54.349、45.993、78.902、49.940、21.934,P值均<0.05）,而AST、TBil、GGT、TBA在不同预后患者中差异均有统计学意义（H值分别为1.728、6.322、6.440、2.353...
- 药物性肝损伤 /
- 临床特点 /
- 危险因素
Abstract:
Objective To investigate the clinical features of drug-induced liver injury (DILI) and related risk factors. Methods A retrospective analysis was performed for the clinical data of 208 patients who were diagnosed with DILI in The Affiliated Hospital of Southwest Medical University from January 2013 to November 2017, including the type of drugs, clinical data, and laboratory examination results, and among these patients, 80 with DILI caused by antitubercular agents, antitumor drugs, and immune agents were enrolled as observation group. A total of 80 patients who used these three types of drugs and did not develop DILI were enrolled as control group. Related risk factors were analyzed. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups. The chi-square test was used for unordered variables of categorical data, the Mann-Whitney U test was used for ranked data, and a logistic regression analysis was used to identify risk factors. Results Of all patients with DILI, 30. 8% had DILI caused by traditional Chinese medicine. There were significant differences in sex, alanine aminotransferase, aspartate aminotransferase (AST) , total bilirubin (TBil) , gamma-glutamyl transpeptidase (GGT) , and total bile acid (TBA) between patients with different types of DILI (χ2= 6. 081, H = 54. 349, 45. 993, 78. 902, 49. 940, and 21. 934, all P < 0. 05) . There were significant differences in AST, TBil, GGT, and TBA between the patients with different prognoses (H = 1. 728, 6. 322, 6. 440, and 2. 353, all P < 0. 05) . Smoking (odds ratio [OR]= 2. 856, P = 0. 026) , diabetes (OR = 2. 726, P = 0. 042) , hyperlipidemia (OR = 3. 390, P = 0. 003) , and body mass index (BMI) ≥28 kg/m2 (OR = 3. 142, P =0. 009) were risk factors for DILI. Conclusion Most DILI cases are caused by traditional Chinese medicine, and hepatocellular type is the most common type of liver injury. Smoking, diabetes, hyperlipidemia, and BMI ≥28 kg/m2 are risk factors for DILI.
- drug-induced liver injury /
- clinical features /
- risk factors

HTML全文

参考文献(18)

[1]WANG G, LIN Y, HOU XF, et al.Discussion on influence factors, mechanism and traditional Chinese medicine pathogenesis of idiosyncratic drug-induced liver injury[J].China J Chin Mater Med, 2017, 42 (16) :3036-3043.

[2]DALAL K, HOLDBROOK T, PEIKI S.Ayurvedic drug induced liver injury[J].World J Hepatol, 2017, 9 (31) :1205-1209.

[3]HU Q, LIU W, SHAO H.Research progress of pharmacotherapy drug-induced liver injury[J].Chin J Clin Pharmacol Ther, 2016, 21 (2) :231-236. (in Chinese) 胡琴, 刘维, 邵宏.药物性肝损伤的药物治疗研究进展[J].中国临床药理学与治疗学, 2016, 21 (2) :231-236.

[4]REGEV A.How to avoid being surprised by hepatotoxicity at the final stages of drug develo-pment and approval[J].Clin Liver Dis, 2013, 17 (4) :749-767.

[5]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.

[6]CHALASANI P, HAYASH H, BONKOVSKY L, et al.ACG Clinical Guideline:the diagnosis and management of idiosyncratic drug-induced liver injury[J].Am J Gastroenterol, 2014, 109 (7) :950-966.

[7]GIORDANO C, RIVAS J, ZERVOS X.An update on treatment of drug-induced liver injury[J].Clin Transl Hepatol, 2014, 2 (2) :74-79.

[8]LI L, JIANG W.Clinical analysis of 275 cases of acute drug-induced liver disease[J].Front Med China, 2007, 1 (1) :58-61.

[9]HALLER C, DYER J, KO R, et al.Making a diagnosis of herbal-related toxic hepatitis[J].West J Med, 2002, 176 (1) :39-44.

[10]GOODMAN Z.Phenotypes and pathology of drug-induced liver disease[J].Clin Liver Dis, 2017, 21 (1) :89-101.

[11]SHAO C, WU C, LI J, et al.Clinical characteristics analysis of122 patients with drug induced liver injury[J].Chin Hepatol, 2012, 17 (9) :451-453.

[12]JI CH, ZHANG ZQ, WANG XY, et al.Clinical features of elderly patients with drug-induced liver injury[J].J Clin Hepatol, 2017, 33 (3) :502-506. (in Chinese) 姬琛华, 张竹青, 王晓媛, 等.老年药物性肝损伤患者临床特征分析[J].临床肝胆病杂志, 2017, 33 (3) :502-506.

[13]CHALASANI N, BONKOVSKY H, FONTANA R, et al.Features and outcomes of 899 pat-ients with drug-induced liver injury:the DILIN prospective study[J].Gastroenterology, 2015, 148 (7) :1340-1352.

[14]LEE W.Drug-induced hepatotoxicity[J].N Engl J Med, 1995, 333 (17) :1118-1127.

[15]LIU LN, ZHAO JX, CHEN WT.et al.Prognostic factors in 138patients with drug-induced liver injury[J].J Pract Hepatol, 2015, 18 (2) :160-163. (in Chinese) 刘丽娜, 赵建学, 陆玮婷, 等.138例药物性肝损伤患者影响预后的因素分析[J].实用肝脏病杂志, 2015, 18 (2) :160-163.

[16]SCHROEDER MJ, HOFFMAN AC.Electronic cigarettes and nicotine clinical pharmacology[J].Tobacco Control, 2014, 23 (Suppl2) :ii30-ii35.

[17]XU LH, ZHANG L, CHEN W, et al.Clinical features and the prognosis of acute drug-induced liver injury[J].J Pract Med, 2013, 29 (3) :3668-3671. (in Chinese) 徐丽红, 张蕾, 陈卫刚, 等.急性药物性肝损伤临床特点及预后分析[J].实用医学杂志, 2013, 29 (3) :3668-3671.

[18]LATIEF M, DAR W, SOFI N, et al.Novel risk factors and early detection of anti tubercular treatment induced liver injury-looking beyond American Thoracic Society Guidelines[J].Indian J Tuberc, 2017, 64 (1) :26-32.

施引文献

资源附件(0)

访问统计