我院精神药物致药物性肝损伤的临床特点及危险因素分析

Clinical characteristics and risk factors of psychotropic drug-induced liver injury in our hospital

目的:探讨我院精神药物致药物性肝损伤的临床特点及危险因素,为临床合理用药提供参考。方法:收集2017年1月–2021年12月在我院精神科住院治疗使用精神药物并发生药物性肝损伤患者的病历,提取相关信息并对药物性肝损伤的临床特点进行分析。另以1∶1随机匹配对照组,采用Logistic回归分析药物性肝损伤的危险因素。结果:纳入分析的153例药物性肝损伤患者中,80.4%的患者为肝细胞损伤型,69.3%的患者为轻度肝损伤,3.3%的患者为重度肝损伤;引起药物性肝损伤的可疑药物主要涉及抗精神病药物(50.8%)、镇静催眠药物(20.3%)和抗抑郁药物(11.8%),其中镇静催眠药多为联用药物。多因素分析结果显示,血脂异常(OR=5.448,95%CI:2.976~9.974)、初次用药(OR=5.217,95%CI:2.770~9.828)和联合用药(OR=2.063,95%CI:1.129~3.771)可使药物性肝损伤发生的风险增加(P<0.05)。结论:我院精神科患者发生药物性肝损伤多为轻度,大多预后良好,但仍需警惕其向重度肝损害发展。临床应避免多重联合用药,重点关注初次使用精神药物并在使用过程中出现血脂异常的患者,注意合理用药并密切监测肝功能。

Objective:To explore the clinical characteristics and risk factors of psychotropic drug-induced liver injury(DILI),and provide references for clinical rational drug use.Methods:Medical records of hospitalized patients who developed DILI in the department of psychiatry of our hospital from January 2017 to December 2021 were collected and analyzed.Logistic regression was used to identify risk factors of DILI after randomly matching the control group with 1∶1.Results:A total of 153 patients were enrolled in this study,among which 80.4%of the patients developed hepatocellular injury,69.3%of the patients developed mild liver injury,and 3.3%of the patients developed severe liver injury.The suspected drugs causing DILI mainly included anti-psychotics(50.8%),sedative-hypnotics(20.3%)and anti-depressants(11.8%),and the sedative-hypnotics were mostly used in combination.Multivariate analysis showed that dyslipidemia(OR:5.448,95%CI:2.976–9.974),initial use of psychotropic drugs(OR:5.217,95%CI:2.770–9.828),and combination medication(OR:2.063,95%CI:1.129–3.771)could significantly increase the risk of DILI(P<0.05).Conclusion:Most DILI in psychiatric patients was mostly mild with a good prognosis,but severe DILI should be vigilant.It was recommended to reduce combination medication,focus on patients who initially used psychotropic drugs and developed dyslipidemia during the treatment,and closely monitor liver function.