药物性肝损伤患者住院时间的影响因素分析  

Influencing factors for the length of hospital stay in patients with drug-induced liver injury

作　　者：杜水仙 芦琳琳[3,4] 辛永宁[2,4] 刘洋[1,2] 袁晨[2,5] 谷九莲[1,2] 宣世英[2,4] 

机构地区：[1]青岛大学医学院,山东青岛266021 [2]青岛市市立医院消化内二科,山东青岛266000 [3]青岛市市立医院中心实验室,山东青岛266000 [4]青岛市消化疾病重点实验室,山东青岛266011 [5]南京医科大学,南京210000

出　　处：《临床肝胆病杂志》2016年第7期1368-1372,共5页Journal of Clinical Hepatology

基　　金：国家科技部十二五"重大新药创制"科技重大专项课题(2012ZX09303-001)

摘　　要：目的分析药物性肝损伤（DILI）患者住院时间的影响因素,以期指导临床,缓解住院压力,减轻患者的经济负担。方法收集2012年1月-2014年12月于青岛市市立医院住院的DILI患者临床资料,包括年龄、性别、原发疾病、用药史、血常规、肝功能检查结果、DILI分型、用药以及转归情况。采用Spearman秩相关、Wilcoxon秩和检验和Kruskal-Wallis H秩和检验对不同因素影响下的患者住院时间进行分析。根据单因素分析结果选择有统计学意义的研究变量进入多重线性回归分析。结果共收集191例DILI患者临床资料,其中男114例,女77例,年龄11-84岁,平均（50.83±2.72）岁,平均住院时间为14（4-41）d。患者年龄、ALT/ALP/TBil的最高水平、凝血酶原活动度（PTA）最低水平与住院时间呈正相关（rs值分别为0.388、0.247、0.172、0.487、0.120,P值均〈0.05）;是否有基础肝病史、高血压病史、恶性肿瘤病史、结核病史、甲状腺功能亢进病史、不同可疑致病药物的使用、DILI治疗方法的不同以及不同分型是DILI患者住院时间的影响因素（P值均〈0.05）;多重线性回归分析结果显示,年龄、基础肝病史、恶性肿瘤病史、中药、解热镇痛药物、ALT/ALP/TBil的最高水平、PTA最低水平、DILI的治疗方法和不同分型是影响患者住院时间的独立危险因素（P值均〈0.05）。结论年龄、基础肝病史、恶性肿瘤病史、中药、解热镇痛药物、ALT/ALP/TBil的最高水平与PTA最低水平、DILI的治疗方法和分型为患者住院时间的影响因素。在临床诊治过程中对住院时间影响因素加以调控,可降低患者住院费用,对减轻医疗卫生负担具有重要作用。Objective To investigate the influencing factors for the length of hospital stay in patients with drug- induced liver injury（ DILI）,and to guide clinical practice,reduce the pressure of hospitalization,and reduce the patients＇ economic burden. Methods The clinical data of the patients with DILI who were hospitalized in Qingdao Municipal Hospital from January 2012 to December 2014 were collected,including age,sex,primary disease,medication history,routine blood test,liver function parameters,DILI type,medication,and prognosis.The Spearman rank correlation,Wilcoxon rank sum test,and Kruskal- Wallis H rank sum test were used to analyze the influencing factors for the length of hospital stay. A multivariate linear regression analysis was performed for the factors with statistical significance determined by the univariate analysis. Results The clinical data of 191 patients with DILI were collected. Among these patients,there were 114 male and 77 female patients aged 11- 84 years（ mean 50. 83 ± 2. 72 years）,and the mean hospital stay was 14 days（ range 4- 41 days）. Patient＇s age,the highest levels of alanine aminotransferase（ ALT） / alkaline phosphatase（ ALP） / total bilirubin（ TBil）,and the lowest level of prothrombin activity（ PTA） were positively correlated with the length of hospital stay（ rs= 0. 388,0. 247,0. 172,0. 487,and 0. 120,all P〈0. 05）. The presence or absence of the histories of underlying liver disease,hypertension,malignant tumors,tuberculosis,and hyperthyroidism,use of different suspected drugs,therapies for DILI,and DILI types were the influencing factors for the length of hospital stay in patients with DILI（ all P〈0. 05）. The multivariate linear regression analysis showed that age,the histories of underlying liver disease and malignant tumors,traditional Chinese medicine,antipyretic and analgesic drugs,the highest levels of ALT / ALP / TBil,the lowest level of PTA,therapies for DILI,and DILI types were independent risk factors for the length of hospital st

关 键 词：药物性肝损伤 住院时间 危险因素 

分 类 号：R575[医药卫生—消化系统]