119例艾滋病患者并发药物性肝损伤的临床特点及预后分析  

Clinical features and prognosis of AIDS complicated by drug-induced liver injury: an analysis of 119 cases

作　　者：杨君洋 齐唐凯[2] 张仁芳[2] 刘莉[2] 沈银忠[2] 纪永佳[2] 卢洪洲[1,2] 

机构地区：[1]温州医科大学,浙江温州325000 [2]复旦大学附属上海市公共卫生临床中心,上海201508

出　　处：《临床肝胆病杂志》2017年第8期1537-1542,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金面上项目(81571977)

摘　　要：目的探讨AIDS患者发生药物性肝损伤(DILI)的临床特点及预后。方法收集2014年1月-2015年12月在上海市公共卫生临床中心感染一科确诊为AIDS并符合DILI诊断的患者119例。分析患者用药情况、CD4^+T淋巴细胞计数、临床表现、肝脏生化指标、治疗方法、肝损伤持续时间及预后,并对患者DILI进行分型及分级,观察不同药物导致的DILI对肝生化指标的影响。计量资料2组间比较采用Wilcoxon秩和检验,多组间比较采用Kruskal-Wallis H检验;计数资料组间比较采用χ~2检验。结果 58例已接受高效抗逆转录病毒治疗患者的肝损伤分级(χ~2=15.756,P<0.001)、TBil水平(Z=-3.466,P=0.010)及Alb水平(Z=-1.968,P=0.049)明显高于61例未接受高效抗逆转录病毒治疗的患者;已明确导致患者DILI的药物种类中8例为抗真菌药物、41例为抗细菌药物、18例为抗结核药物、24例为抗病毒药物,抗结核药物较其他3种药物所致DILI患者的TBil水平更高(H=12.804,P=0.005),抗细菌药物及抗结核药物所致DILI的Alb水平低于其他2组(H=14.236,P=0.003),抗结核药物及抗病毒药物造成的肝损伤等级明显高于抗细菌药物和抗真菌药物(χ~2=16.373,P=0.008)。肝细胞损伤型患者住院治疗时间较短(χ~2=8.046,P=0.045);高水平ALP、低水平ALT提示需较长时间住院治疗(Z值分别为-2.943、-2.592,P值均<0.05)。结论 AIDS患者用药复杂,易并发DILI,高效抗逆转录病毒治疗可在一定程度上加重肝损伤,但对患者预后影响不明显。临床用药过程中应定期检查肝功能,实时了解肝脏炎症活动状态,有助于减少AIDS患者的DILI发生率。Objective To investigate the clinical features and prognosis of AIDS patients complicated by drug-induced liver injury（ DILI）. Methods A total of 119 patients who were diagnosed with AIDS in First Department of Infectious Diseases in Shanghai Public Health Clinical Center from January 2014 to December 2015 and met the diagnostic criteria for DILI were enrolled. The clinical data including medications,CD4~＋T lymphocyte count,clinical manifestations,liver biochemical parameters,therapies,duration of liver injury,and prognosis were analyzed,and DILI type and classification were determined for all patients. The influence of DILI caused by different drugs on liver biochemical parameters was analyzed. The Wilcoxon rank sum test was used for comparison of continuous data between two groups and the Kruskal-Wallis H test was used for comparison between multiple groups; the chi-square test was used for comparison of categorical data between groups. Results The 58 patients who received highly active antiretroviral treatment（ HAART） had significantly higher grade of liver injury（ χ~2= 15. 756,P 0. 001） and levels of total bilirubin（ TBil）（ Z =-3. 466,P = 0. 010） and albumin（ Alb）（ Z =-1. 968,P = 0. 049） than the 61 patients who did not. Among the patients who had a clear cause of DILI,8 had DILI caused by antifungal drugs,41 had DILI caused by antibacterial drugs,18 had DILI caused by antitubercular agents,and 24 had DILI caused by antiviral drugs; the patients with DILI caused by antitubercular agents had a significantly higher level of TBil than those with DILI caused by other three types of drugs（ H = 12. 804,P = 0. 005）,the patients with DILI caused by antibacterial drugs and antitubercular agents had a significantly lower level of Alb than those with DILI caused by the other two types of drugs（ H = 14. 236,P = 0. 003）,and the patients with DILI caused by antitubercular agents and antiviral drugs had a significantly higher grade of liver injury than those with DILI caused by the oth

关 键 词：获得性免疫缺陷综合征 药物性肝损伤 预后 

分 类 号：R512.91[医药卫生—内科学] R575[医药卫生—临床医学]