药物性肝损伤患者长期预后的影响因素分析

Analysis of factors affecting long-term prognosis of patients with drug-induced liver injury

目的探讨DILI患者预后的影响因素。方法筛选2016年1月至2020年6月东部战区总医院淮安医疗区入院治疗的DILI患者126例,根据病情将患者分为缓解组、未愈组。比较两组患者的一般情况,实验室检查结果、用药情况等,统计学处理采用t检验、卡方检验;单因素和多因素Logistic回归分析DILI患者预后的影响因素。结果126例DILI患者治疗缓解92例,治疗未愈34例。对缓解组、未愈组患者临床资料进行单因素分析可知,缓解组年龄为(43.7±9.6)岁,未愈组年龄为(51.6±10.3)岁,两组年龄差异有统计学意义(t=5.192,P<0.05)。缓解组ALT、AST、INR分别为(94.2±40.5)U/L、(108.8±35.2)U/L、(1.9±1.1),未愈组分别为(350.4±204.8)U/L、(320.1±92.0)U/L、(1.2±0.3),差异均有统计学意义(t=14.829、12.028、10.914,均P<0.05)。缓解组患者使用西药66例(71.7%)、中药/中成药9例(9.8%)、联合应用17例(18.5%),未愈组患者使用西药14例(41.2%)、中药/中成药8例(23.5%)、联合应用12例(35.3%),差异有统计学意义(χ^(2)=26.278,P<0.05)。将年龄、ALT、AST、INR及药物种类设为自变量,DILI患者预后状态设为应变量(赋值0=缓解,1=未愈),多因素分析结果提示INR、药物种类是DILI患者预后的独立影响因素。结论INR、药物种类是DILI患者预后的独立影响因素。

Objective To analyze the clinical data of patients with drug-induced liver injury(DILI)and explore the prognostic factors of DILI patients.Methods A total of 126 patients with DILI in hospital from January 2016 to June 2020 were selected.The diagnosis of DILI was in accordance with the guidelines for the diagnosis and treatment of DILI.According to the condition,the patients were divided into remission group and uncured group.The measurement data were expressed as(±s)and analyzed by t-test,count data were expressed as(%)and chi-square test was used,univariate and multivariate Logistic regression analysis were performed to determine the independent predictive factors affecting the prognosis of patients with DILI.Results Of the 126 patients with DILI,92 patients were treated with remission(remission group)and 34 patients with uncured treatment(uncured group).Univariate analysis of the clinical data of patients in remission group and uncured group showed that the age of remission group was(43.7±9.6)years,and that of uncured group was(51.6±10.3)years.There was significant difference between the two groups(Z=5.192,P<0.05).The ALT,AST and INR in remission group were(94.2±40.5)u/l,(108.8±35.2)u/l and(1.9±1.1),which were significantly lower than those in uncured group[(350.4±204.8)u/l,(320.1±92.1)and(1.2±0.3),Z=14.829、12.028、10.914,P<0.05].In the remission group,there were 66 cases of western medicine(71.7%),9 cases of traditional Chinese medicine/proprietary Chinese medicine(9.8%),17 cases of combined use(18.5%).And in the uncured group,there were 14 cases of western medicine(41.2%),8 cases of traditional Chinese medicine/proprietary Chinese medicine(23.5%)and 12 cases of combined use(35.3%).The difference was statistically significant(Z=26.278,P<0.05).Age,ALT,AST,INR and the type of drugs were set as independent variables,and the prognostic status of patients with DILI was set as dependent variables(assignment 0=remission,1=not cured).The results of multivariate analysis showed that INR and the type of drugs were independent predictors of prognosis in patients with DILI.Conclusion INR and the type of drugs are independent predictive factors affecting the prognosis of patients with DILI.In the process of clinical drug use,attention should be paid to the use of type of drugs.