药物性肝损伤的临床特点及其预后评估

目的 总结药物性肝损伤(DILI) 的临床特点,探讨评估DILI预后的因素.方法 回顾性分析近5年安徽医科大学第一附属医院消化内科DILI的106例临床资料,运用Logistic回归分析筛选影响预后的指标.结果 DILI病人女性较多(61例,57.5%) ,平均年龄(51.9±16.9)岁,用药以中药、抗菌类及解热镇痛类为主.肝细胞型DILI多见(86例,81.1%),严重程度分级中以中度居多(58例,54.7%),97例(91.5%)病人预后良好.不同严重程度肝细胞型DILI间Hy′s 法则符合率不同(P<0.05),符合此法则的肝细胞型DILI病人肝衰竭的发生率为22.9%(11/48).多因素回归分析显示:影响预后的指标为丙氨酸氨基转移酶(ALT)(OR=1.672,P<0.05)、国际标准化比值(INR)(OR=8.852,P<0.05).结论 DILI病人大部分预后较好.发病时ALT及INR是预测DILI预后的独立指标.

Clinical features and prognostic evaluation of patients with drug-induced liver injury

Objective To summarize the clinical characteristics of patients with drug-induced liver injury(DILI) and investigate the prognostic evaluation factors of DILI.Methods The clinical data of hospitalized DILI patients in recent five years were analyzed retrospectively.Factors effecting on prognosis were selected by Logistic regression analysis.Results Among the 106 patients,female was 61(57.5%),the mean age was (51.9±16.9) years old.Chinese herbal medicines,antibacterial and antipyretic analgesic drugs accounted for the major part of medications.The percentage of hepatocellular pattern was 81.1%.The most common severity grade of DILI was moderate (54.7%).91.5% patients were good prognosis.There was significant difference between Hy′s law coincidence rate in different severity of DILI (P< 0.05).The incidence rate of liver failure in accordance with Hy′s law in hepatocellular pattern of DILI was 22.9% (11/48).Multivariate regression analysis showed that the prognostic factors were ALT (OR=1.672,P<0.05) and international normalized ratio (INR) (OR=8.852,P<0.05).Conclusion The majority of patients with DILI had a good prognosis.ALT and INR at DILI recognition are the independent factors for predicting the prognosis of DILI.