低氧条件下药物性肝损伤的临床特征及预后分析

Clinical features and prognosis of drug-induced liver injury under hypoxia conditions

背景随着新药的不断问世,药物性肝损伤(drug-induced liver injury,DILI)的发病率也相应增加,但由于DILI诊断缺乏特异性,容易造成漏诊及误诊.青海地处高原,低氧是主要环境特征,本文对我院近6年DILI的诊治情况进行总结分析,拟发现低氧条件下DILI的临床特点.目的探讨低氧条件下DILI的临床特征及预后的影响因素.方法回顾性分析青海地区近6年收治的247例DILI病例的年龄、性别、民族、饮酒史、可疑肝损伤药物、临床表现、实验室检查等内容.结果青海地区引起DILI男女比例为1:1.2,年龄集中在40-59岁(125例,50.61%),前三位药物分别是中药、感冒药及藏药,245例(99.19%)有临床症状,以乏力为主,247例患者中肝细胞损伤型146例(59.11%),胆汁淤积型51例(20.65%),混合型50例(20.24%).247例患者好转出院232例(93.93%),死亡15例(6.07%).预后的危险因素为年龄(OR=0.39,P=0.05)、民族(OR=3.13,P=0.01)、初始白蛋白水平(OR=1.01,P=0.01)、凝血酶原时间[prothrombin time,PT(OR=1.51,P=0.01)].结论引起DILI的药物种类繁多,临床表现缺乏特异性,年龄大、白蛋白水平低、PT高的患者预后不良的风险增加.

BACKGROUND With the advent of new drugs,the incidence of druginduced liver injury(DILI)has increased.However,due to the lack of specificity in DILI diagnosis,it is easy to cause missed diagnosis and misdiagnosis.Qinghai is located in the Qinghai-Tibet plateau plateau,and hypoxia is the main environmental characteristic.This paper summarized and analyzed the diagnosis and treatment of DILI at our hospital in the past 6 years,with an aim to identify the clinical characteristics of DILI under hypoxia conditions.AIM To investigate the clinical features and prognostic factors of DILI under hypoxia conditions.METHODS The data including age,gender,ethnicity,drinking history,suspected liver injury drugs,clinical manifestation,and laboratory findings of 247 cases of DILI admitted to Qinghai Provincial People’s Hospital in recent 6 years were analyzed retrospectively.RESULTS The male-to-female ratio was 1:1.2,and the age group of 40-59 years(125 cases,50.61%)was most commonly affected.The top three drugs were traditional Chinese medicine,cold medicine,and Tibetan medicine.A total of 245(99.19%)patients had clinical symptoms,with fatigue being the most common.Of 247 patients included,146(59.11%)had hepatocellular injury type,51(20.65%)had cholestasis type,and 50(20.24%)had mixed type;232(93.9%)improved and were discharged from hospital and 15(6.07%)died.The prognostic risk factors were age(OR=0.39,P=0.05),ethnicity(OR=3.13,P=0.01),initial albumin level(OR=1.01,P=0.01),and prothrombin time[PT(OR=1.51,P=0.01)].CONCLUSION There are many kinds of drugs causing DILI,and the clinical manifestations are not specific.Patients with old age,low albumin level,and high PT have an increased risk of poor prognosis.