138例药物性肝损伤患者影响预后的因素分析

Prognostic factors in patients with drug-induced liver injuries

目的探讨影响药物性肝损伤（DILI）预后的因素。方法 2008年7月至2014年7月在我院住院期间发生DILI患者69例,采用Logistic回归分析影响预后的各个因素。结果本组患者发病年龄主要在50-59岁,女性患者多于男性,肝细胞型占78.3%;各年龄段患者临床类型无显著性差异（P〉0.05）;76.1%DILI患者预后良好,未愈者占23.9%;中药引发的DILI占43.5%,且预后较其他种类药引起者差;患者在住院期间恢复还是未愈与患者性别、年龄、用药至发病时间或是否合并慢性疾病无显著性相关（P〉0.05）,而与临床类型、是否有过敏史、发病时是否出现免疫特性临床表现有显著性相关（P〈0.05）;初始发病时血清总胆红素、总胆汁酸和碱性磷酸酶水平是预测预后的较好指标（P〈0.05）。结论 DILI患者预后主要取决于用药种类和个体体质差异,初始发病时肝功能指标对预后有一定的预测意义。

Objective To investigate the prognostic factors of drug-induced liver injury（DILI）. Methods Sixty-nine patients with DILI were included in this study from July 2008 to July 2014. The factors were as-sessed by Logistic regression analysis. Results The ages of patients with DILI were mainly among 50 to 59 year old. The number of female patients was more than male ones. The most common clinical manifestation in this series was hepatocyte type（78.3%）,the second was cholestasis type and the third was mixed type. The pa-tients at different ages had no significant difference in clinical types（P〉0.05）. The recovered patients accounted for 76.1%,and the unrecovered one was 23.9%. TCM-induced DILI accounted for 43.5% of patients and their prognosis was relatively poor.The prognosis of DILI was not associated with age,gender,and underlying chronic diseases（P〉0.05）,but significantly associated with the clinical type,history of allergies and immune characteristic clinical manifestation（P〈0.05）. The total bilirubin,total bile acid and alkaline phosphatase were the independent predictors for prognosis of DILI patients（P〈0.05）. Conclusion The prognosis of patients with DILI mainly de-pends on the drug category and the individual physical features.