不同类别药物致肝损伤的临床特征及预后因素Logistic回归分析  

Clinical characteristics of liver injury induced by different types of drugs and Logistic analysis of the influencing factors on the prognosis

作　　者：张亚飞 操艺[1] 王志豪 王媛媛[1] ZHANG Yafei;CAO Yi;WANG Zhihao;WANG Yuanyuan(Department of Pharmacy,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院药学部,合肥230601

出　　处：《药物流行病学杂志》2025年第4期410-418,共9页Chinese Journal of Pharmacoepidemiology

基　　金：安徽省高校自然科学研究重点项目(2022AH050773);安徽医科大学校科研基金立项资助项目(2022xkj043)。

摘　　要：目的分析不同类别药物致药物性肝损伤(DILI)的临床特征,探究影响DILI预后的相关因素。方法回顾性收集我院2019年1月1日—2023年12月31日确诊DILI患者的病历信息,分析不同类别药物致DILI的临床特征,采用多因素Logistic回归模型分析DILI的预后影响因素。结果共纳入347例DILI患者。DILI分型以肝细胞损伤型为主(67.15%),其次是胆汁淤积型(20.46%)和混合型(12.39%)。致DILI的药物类别排名前3位分别为中药(25.34%)、抗肿瘤药物(24.15%)及抗感染药物(21.26%)。预后方面,治愈7例(2.02%),好转269例(77.52%),未愈71例(20.46%)。不同预后组患者的年龄、性别、丙氨酸转氨酶水平、天冬氨酸转氨酶水平、碱性磷酸酶水平、DILI分型、联合使用保肝药品种数以及致DILI的药物类别等差异均有统计学意义(P<0.05)。Logistic回归分析显示,胆汁淤积型[OR=0.237,95%CI(0.083,0.673),P=0.007]、联合使用2种以上保肝药[OR=0.551,95%CI(0.295,0.998),P=0.018]是DILI预后的独立危险因素。结论联合使用保肝药种数和DILI分型可作为评估DILI预后的潜在指标。临床应关注中药、抗肿瘤药物、抗感染药物的潜在肝毒性,合理选择治疗用药,提高DILI防治水平。Objective To analyze the clinical characteristics of drug-induced liver injury(DILI)caused by different drug categories,and to investigate factors influencing DILI prognosis.Methods Medical records of DILI patients diagnosed in our hospital from January 1,2019 to December 31,2023 were retrospectively collected.Clinical characteristics of DILI induced by different drug categories were analyzed.Multivariate Logistic regression was employed to identify prognostic factors of DILI.Results A total of 347 DILI patients were included.The predominant DILI pattern was hepatocellular injury(67.15%),followed by cholestatic(20.46%)and mixed types(12.39%).The top three causative drug categories were traditional Chinese medicine(25.34%),antineoplastic drugs(24.15%)and anti-infective agents(21.26%).Regarding prognosis outcomes,7 cases(2.02%)achieved complete recovery,269 cases(77.52%)showed improvement,and 71 cases(20.46%)demonstrated no improvement.Significant differences were observed among prognosis groups in age,gender,alanine aminotransferase level,aspartate transaminase level,alkaline phosphatase levels,DILI patterns,number of combined hepatoprotective drugs used,and causative drug categories(P<0.05).Multivariate analysis revealed that cholestatic type[OR=0.237,95%CI(0.083,0.673),P=0.007]and combination therapy with>2 hepatoprotective drugs[OR=0.551,95%CI(0.295,0.998),P=0.018]were independent risk factors for prognosis.Conclusion The number of hepatoprotective drugs used in combination and DILI patterns may serve as potential indicators for prognosis evaluation.Particular attention should be paid to the hepatotoxicity of traditional Chinese medicine,antineoplastic agents,and anti-infective drugs.Rational drug selection is essential for improving DILI prevention and treatment.

关 键 词：药物性肝损伤 临床特征 用药史 预后分析 影响因素 

分 类 号：R595.3[医药卫生—内科学]