某院76例低分子肝素治疗肺血栓栓塞症患者致肝功能异常的风险评估

Risk Evaluation of Abnormal Liver Function Associated with LMWH in 76 PTE Patients of Our Hospital

目的探索低分子肝素(low molecular weight heparin,LMWH)治疗肺血栓栓塞症过程中引起肝功能损伤的临床规律和危险因素。方法收集本院2008年1月至2016年12月使用LMWH治疗肺血栓栓塞症的住院患者信息。结果共纳入患者97例,其中76例患者药物不良反应相关性评价为"很可能"和"可能"。单因素分析提示发生肝功能异常患者的血清肌酐水平(P=0.000)、谷丙转氨酶(P=0.000)、谷草转氨酶(P=0.000)、γ-谷氨酰转肽酶(P=0.000)、碱性磷酸酶(P=0.023)、伴感染性疾病率(P=0.024)和内生肌肝清除率(P=0.026)显著高于非异常者;多因素回归显示伴感染性疾病(OR=1.982,P=0.022)和高血清肌酐水平(OR=1.045,P=0.000)为发生肝功能异常的独立危险因素。结论使用低分子肝素治疗肺血栓栓塞症肝功能异常的发生率较高,高Scr水平和/或合并感染者是发生肝功能异常的危险因素。应在用药期间密切监测患者肝脏功能,必要时予对症处理。

OBJECTIVE To explore the clinical regularities and risk factor of abnormal liver function associated with LMWH in pulmonary thromboembolism patients. METHODS Clinical date of pulmonary thromboembolism patients in use of LMWH was collected and analyzed from January 2008 to December 2016. RESULTS 97 cases were enrolled. Of them,there were 76 cases were assessed as probable or possible. Single factor analysis showed the the levels of Scr（ P = 0. 000）,ALT（ P = 0. 000）,AST（ P =0. 000）,γ-GGT（ P = 0. 000）,ALP（ P = 0. 023）,co-infection（ P = 0. 024） and Ccr（ P = 0. 026） had statistically significant difference. Multivariate analysis indicated that co-infection（ OR = 1. 982,P = 0. 022） and high level of Scr（ OR = 1. 045,P = 0. 000）were the independent risk factors of abnormal liver function associated with LMWH in PTE. CONCLUSION The incidence of abnormal liver function due to LMWH in PTE patients is high. With high level of Scr and/or co-infection patients are high-risk persons of abnormal liver function. It is necessary to dynamically evaluate the liver function during hospitalization. Symptomatic treatment can be significant if the liver function become abnormal.