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药物性肝损伤的临床特点及危险因素分析
Clinical features of drug-induced liver injury and related risk factors
文章发布日期:2018年05月07日  来源:  作者:林云霞,何晓彬  点击次数:505次  下载次数:97次

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【摘要】:目的探讨药物性肝损伤(DILI)的临床特点及危险因素。方法回顾性分析2013年1月-2017年11月在西南医科大学附属医院诊断为DILI的208例患者的药物种类、临床资料和实验室检查,分析DILI的临床特点。其中使用抗结核药、肿瘤药、免疫制剂致DILI的患者80例作为观察组,另选取同期在该院使用该3种药物但未发生DILI的患者80例作为对照组,进行危险因素分析。正态分布的计量资料多组间比较采用方差分析;非正态分布计量资料多组间比较采用Kruskal-Wallis H检验。计数资料的无序变量组间比较采用χ2检验;等级变量采用Mann-Whitney U检验,logistic回归分析危险因素。结果以中药引起DILI的患者所占比例最大(308%);不同类型DILI之间性别、ALT、AST、TBil、GGT、总胆汁酸(TBA)差异均有统计学意义(χ2=6.081,H值分别为54.349、45.993、78.902、49.940、21.934,P值均<0.05),而AST、TBil、GGT、TBA在不同预后患者中差异均有统计学意义(H值分别为1728、6.322、6.440、2.353,P值均<0.05)。吸烟[比值比(OR)=2.856,P=0.026]、糖尿病(OR=2.726,P=0.042)、高脂血症(OR=3390,P=0.003)、BMI≥28 kg/m2(OR=3.142,P=0.009)是DILI的危险因素。结论DILI以中药引起的患者最多,肝损伤类型以肝细胞型为主,有吸烟史、糖尿病、高脂血症、BMI≥28 kg/m2是DILI的危险因素。
【Abstract】:ObjectiveTo investigate the clinical features of drug-induced liver injury (DILI) and related risk factors. MethodsA retrospective analysis was performed for the clinical data of 208 patients who were diagnosed with DILI in The Affiliated Hospital of Southwest Medical University from January 2013 to November 2017, including the type of drugs, clinical data, and laboratory examination results, and among these patients, 80 with DILI caused by antitubercular agents, antitumor drugs, and immune agents were enrolled as observation group. A total of 80 patients who used these three types of drugs and did not develop DILI were enrolled as control group. Related risk factors were analyzed. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups. The chi-square test was used for unordered variables of categorical data, the Mann-Whitney U test was used for ranked data, and a logistic regression analysis was used to identify risk factors. ResultsOf all patients with DILI, 30.8% had DILI caused by traditional Chinese medicine. There were significant differences in sex, alanine aminotransferase, aspartate aminotransferase (AST), total bilirubin (TBil), gamma-glutamyl transpeptidase (GGT), and total bile acid (TBA) between patients with different types of DILI (χ2=6.081, H=54.349, 45.993, 78902, 49.940, and 21.934, all P<0.05). There were significant differences in AST, TBil, GGT, and TBA between the patients with different prognoses (H=1.728, 6.322, 6.440, and 2.353, all P<0.05). Smoking (odds ratio [OR]=2.856, P=0.026), diabetes (OR=2.726, P=0.042), hyperlipidemia (OR=3.390, P=0.003), and body mass index (BMI) ≥28 kg/m2 (OR=3.142, P=0009) were risk factors for DILI. ConclusionMost DILI cases are caused by traditional Chinese medicine, and hepatocellular type is the most common type of liver injury. Smoking, diabetes, hyperlipidemia, and BMI ≥28 kg/m2 are risk factors for DILI.
【关键字】:药物性肝损伤; 临床特点; 危险因素
【Key words】:drug-induced liver injury; clinical features; risk factors
【引证本文】:
LIN YX, HE XB. Clinical features of drug-induced liver injury and related risk factors[J]. J Clin Hepatol, 2018, 34(6): 1237-1241. (in Chinese) 林云霞, 何晓彬. 药物性肝损伤的临床特点及危险因素分析[J]. 临床肝胆病杂志, 2018, 34(6): 1237-1241.

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