首乌制剂相关肝损伤伴或不伴自身抗体阳性患者临床特征比较  

Clinical features of Polygonum multiflorum preparation-related liver injury with or without positive autoantibody

作　　者：蔡静 周桂琴[2] 刘亚兴 李斌[2] 王晓静[2] 冯颖[2] 王宪波[2] CAI Jing;ZHOU Guiqin;LIU Yaxing;LI Bin;WANG Xiaojing;FENG Ying;WANG Xianbo(The First Clinical Medical College,Beijing University of Chinese Medicine,Beijing 100700,China;Center of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]北京中医药大学第一临床医学院,北京100700 [2]首都医科大学附属北京地坛医院中西医结合中心,北京100015

出　　处：《临床肝胆病杂志》2022年第10期2296-2301,共6页Journal of Clinical Hepatology

基　　金：首都卫生发展科研专项(2018-1-2172);国家科技重大专项(2018ZX10723203);2019年重大疑难疾病中西医临床协作能力建设(2019-285)。

摘　　要：目的 基于倾向性评分匹配对比分析首乌制剂相关肝损伤伴自身抗体阳性患者与不伴自身抗体阳性患者的临床特征,探讨合并自身抗体对首乌制剂相关肝损伤患者预后的影响。方法 选取首都医科大学附属北京地坛医院2008年8月—2021年6月首乌制剂相关肝损伤住院患者364例,根据是否检测到自身抗体分为自身抗体阴性组(H0组)和自身抗体阳性组(H1组),其中H0组157例,H1组207例,采用倾向性评分匹配方法进行混杂因素校正,比较两组患者肝损伤达峰值时生化指标、肝损伤严重程度、肝损伤分型及疾病转归情况的差异。正态分布的计量资料两组间比较采用t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验。计数资料或等级资料组间比较采用χ^(2)检验或Mann-Whitney U秩和检验。应用Cox回归模型分析肝功能恢复的影响因素。通过Kaplan-Meier法绘制生存曲线,并用Log-rank检验进行比较。结果 倾向性评分匹配后,成功匹配98对病例。两组肝损伤达峰值时生化指标比较结果显示,H1组ALP、球蛋白、总胆汁酸水平均高于H0组,Alb水平低于H0组,差异均有统计学意义(P值均<0.05)。两组患者肝损伤分型差异无统计学意义(P>0.05)。肝损伤严重程度方面两组比较差异有统计学意义(Z=1.710,P=0.045)。自身抗体以抗核抗体(ANA)阳性为主,占比49%;不同ANA抗体滴度患者肝损伤严重程度比较,差异有统计学意义(Z=20.252,P=0.001)。疾病转归以半年内肝功能恢复正常进行比较,H0、H1组半年肝功能复常率分别为90.8%和75.5%,H1组肝功能复常率偏低(χ^(2)=8.199,P=0.004)。Cox回归分析显示自身抗体(HR=5.248,95%CI:1.554~17.718,P=0.008)和ALP(HR=1.013,95%CI:1.002~1.025,P=0.026)是肝功能恢复的独立危险因素。Kaplan-Meier生存曲线结果显示,半年后自身抗体阳性组患者肝功能未恢复的风险较自身抗体阴性组更高(χ^(2)=8.802,P=0.003)。结论 Objective To investigate the clinical features of patients with Polygonum multiflorum preparation-related liver injury with or without positive autoantibody based on propensity score matching,as well as the influence of positive autoantibody on the prognosis of such patients.Methods A total of 364 patients with Polygonum multiflorum preparation-related liver injury who were hospitalized in Beijing Ditan Hospital,Capital Medical University,from August 2008 to June 2021 were enrolled,and according to whether autoantibodies were detected,they were divided into negative autoantibody group(H0 group) with 157 patients and positive autoantibody group(H1 group) with 207 patients.After adjustment for confounding factors by propensity score matching,the two groups were compared in terms of biochemical parameters,severity of liver injury,classification of liver injury,and disease outcome when liver injury reached the peak.The t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Mann-Whitney U rank sum test was used for comparison of categorical data or ranked data between two groups.The Cox regression model was used to analyze the influencing factors for liver function recovery.The Kaplan-Meier method was used to plot survival curves,and the Log-rank test was used for comparison between groups.Results A total of 98 pairs of cases were successfully matched after propensity score matching.Comparison of biochemical parameters between the two groups at the peak of liver injury showed that compared with the H0 group,the H1 group had significantly higher levels of alkaline phosphatase(ALP),globulin,and total bile acid and a significantly lower level of albumin(all P<0.05).There was no significant difference in the classification of liver injury between the two groups(P>0.05),and there was a significant difference in the severity of liver injury

关 键 词：化学性与药物性肝损伤 何首乌 自身抗体 

分 类 号：R575[医药卫生—消化系统]