不同类别药物致急性药物性肝损伤的临床特征比较及严重程度影响因素分析

目的： 分析不同类别药物致急性药物性肝损伤（drug-induced liver injury， DILI）的临床特征及严重程度的影响因素。方法： 收集2017年1月至2021年6月湖南省人民医院收治的急性DILI患者的病历资料，对患者的临床特征及肝损伤严重程度的影响因素进行回顾性分析。结果： 共纳入309例病例，其中肝损伤严重程度<3级的171例，≥3级（严重DILI）的138例。多因素Logistic回归分析结果显示，药物类别和高脂血症是发生严重DILI的独立影响因素（P<0.05）；在不同药物类别中，与全身抗感染药组相比，中草药组和保健品组OR值均大于1，抗肿瘤或免疫机能调节药组OR值小于1（P<0.05）。结论： 药物类别和高脂血症是发生严重DILI的独立影响因素；中草药和保健品引起严重DILI的风险显著高于全身抗感染药，抗肿瘤或免疫机能调节药引起严重DILI的风险显著低于全身抗感染药。临床工作者应对存在严重DILI风险的患者开展重点监护，实现早发现、早停药、早治疗。

Comparison of clinical characteristics and analysis of influencing factors of severity of acute drug-induced liver injury caused by different types of drugs

OBJECTIVE To analyze the clinical features and influencing factors of severity of acute drug-induced liver injury(DILI) caused by different types of drugs.METHODS The medical records of patients admitted to Hunan Provincial People's Hospital with acute DILI from January 2017 to June 2021 were collected, and the clinical characteristics and the influencing factors of liver injury severity were analyzed retrospectively.RESULTS Among 309 cases, the severity of liver injury was less than grade 3 in 171 cases and more than or equal to grade 3(severe DILI) in 138 cases. Multivariate logistic regression analysis showed that drug classification and hyperlipidemia were independent risk factors for severe DILI(P<0.05); in the drug classification, compared to that of systemic anti-infective drugs, the OR values of Chinese herbal medicine group and health care product group were both more than 1, and the OR values of antitumor drug group and immune function modulator group were both less than 1(P<0.05).CONCLUSION Drug classification and hyperlipidemia are independent risk factors for severe DILI; the risk of severe DILI caused by Chinese herbal medicine and health care products is significantly higher than that of systemic anti-infective drugs, and the risk of severe DILI caused by antitumor and immune function modulators is significantly lower than that of systemic anti-infective drugs. Clinicians should carry out intensive monitoring for patients at risk of severe DILI to achieve early detection, early drug withdrawal and early treatment.