卡泊芬净相关肝损伤的真实世界研究

目的：研究真实世界卡泊芬净相关肝损伤的发生情况和危险因素，为临床安全使用卡泊芬净提供参考。方法：通过信息系统提取2019年1月至2020年7月武汉市第一医院使用醋酸卡泊芬净的出院患者病历，根据《药物性肝损伤诊治指南（2015年版）》对卡泊芬净相关肝损伤病例进行回顾性分析，使用RousselUclaf因果关系评估法（RUCAM）评估因果关系，以国际医学组织理事会（CIOMS）的判断标准进行临床分型并进行严重程度分级，最后对发生药物性肝损伤的相关危险因素进行分析。结果：共纳入218例患者，肝损伤发生率为6.9%，多发生于用药14 d内，以胆汁淤积型（53.3%）和肝细胞损伤型（33.3%）多见，轻中度肝损伤占93.6%。二元Logistic回归分析显示血清白蛋白水平越低卡泊芬净相关肝损伤的风险越高，具有统计学意义（OR=1.347，95% CI 1.166~1.556，P<0.001）。结论：卡泊芬净用药期间需监护患者肝功能，特别是用药的前14 d和低蛋白血症患者。

Liver injury associated with caspofungin: a real-world study

OBJECTIVE To explore the incidence and risk factors of caspofungin related liver injury in the real world to provide reference for safe dosing of caspofungin in clinical practices.METHODS Medical records of 218 discharged patients receiving caspofungin acetate from January 2019 to July 2020 were extracted from hospital information system. And caspofungin related liver injuries were retrospectively analyzed according to the Guideline of Diagnosis and Treatment of Drug-induced Liver Injury (2015). The RousselUclaf causality assessment method (RUCAM) was employed for evaluating causality and clinical classification and severity grading were performed according to the judgment criteria of International Council of Medical Organizations (CIOMS). Finally the risk factors related to drug-induced liver injury were analyzed.RESULTS Among them, the incidence of liver injury was 6.9% occurring mostly within 14 days of medication. Cholestasis (53.3%) and hepatocyte injury (33.3%) predominated and mild/moderate liver injury accounted for 93.6%. Binary Logistic regression analysis indicated that a lower serum level of albumin was correlated with a higher risk of caspofungin-related liver injury. It was statistically significant (OR=1.347, 95%CI:1.166-1.566, P<0.001).CONCLUSION Liver function of patients with hypoproteinemia should be closely monitored during the administration of caspofungin, especially during initial 14 days.