69例药物性肝损伤患者临床分型与中医体质的相关性分析

Correlation analysis between clinical classification and TCM constitution in 69 cases of drug⁃induced liver injury

目的分析药物性肝损伤患者临床分型与中医体质的相关性。方法借助医院住院病历系统收集药物性肝损伤患者的一般资料(年龄、性别、过敏史等)、实验室指标、导致肝损伤的药物信息及中医体质资料,根据R值进行临床分型(肝细胞损伤型、胆汁淤积型、混合型),结合调查问卷结果(电话随访)根据相关标准进行中医体质分类(平和质、气虚质、气郁质、阳虚质、阴虚质、湿热质、痰湿质、血瘀质、特禀质)。采用Logistic回归分析方法分析药物性肝损伤临床分型与中医体质的相关性。结果①本研究共纳入69例药物性肝损伤患者,女性为多(76.8%),女性平均年龄(51.06±12.19)岁、男性平均年龄(45.88±12.51)岁,有过敏史者11例。②临床分型肝细胞损伤型29例,胆汁淤积型23例,混合型17例。③中药及其制剂[多含何首乌(61.9%)、雷公藤(28.6%)]、解热镇痛类药物、保健品引起的药物性肝损伤居多(分别占30.4%、15.9%、13.0%)。④69例患者以平和质、气虚质、特禀质、气郁质居多,分别占39.1%、15.9%、14.5%、13.0%。⑤特禀质与肝细胞损伤型(P<0.05)、胆汁淤积型(P<0.05)临床分型有相关性,是影响药物性肝损伤胆汁淤积型临床分型的相关因素[OR=6.271,95%CI(1.443,27.253)]。结论特禀质药物性肝损伤患者易出现胆汁淤积,临床对于特禀质人群选方用药应更加谨慎,一旦发生药物性肝损伤,除及时停药外,还应积极给予祛除胆汁淤积、抑制免疫炎症风暴相关治疗,防止病情迅速进展。

Objective To analyze the clinical classification of patients with drug-induced liver injury(DILI)and its correlation with TCM constitution.Methods General data(age,gender,and history of allergy,etc.),laboratory indicators,drug information causing liver injury and TCM constitutions of patients with DILI were collected through hospital inpatient medical record system.Clinical classification(hepatocellular injury type,cholestasis type,and mixed type)was conducted according to R value.TCM constitution(normal type,qi-deficiency type,qi-stagnation type,yang-deficiency type,yin-deficiency type,damp-heat type,phlegm-damp type,blood stasis type,and special endowment type)was classified according to relevant criteria and the results of the questionnaire(telephone follow-up).Logistic regression analysis was used to analyze the correlation between clinical classification and TCM constitution in DILI cases.Results①A total of 69 DILI cases were included in this study,and 76.8%were female with an average age of(51.06±12.19)years,while the average age of men was(45.88±12.51)years.There were 11 cases with a history of allergy.②There were 29 cases of hepatocellular injury type,23 cases of cholestasis type,and 17 cases of mixed type.③Most DILI was caused by traditional Chinese herbal medicines(TCHMs)and preparations[mostly containing Polygoni Multiflori Radix(61.9%)and Tripterygium wilfordii(28.6%)],antipyretic and analgesic drugs,and health care products(30.4%,15.9%,and 13.0%,respectively).④The majority constitution types of 69 patients were normal type,qi-deficiency type,special endowment type and qi-stagnation type(39.1%,15.9%、14.5%and 13.0%,respectively).⑤The special endowment type was correlated with the clinical classification of hepatocellular injury type(P<0.05)and the cholestasis type(P<0.05),and was a relevant factor influencing the cholestasis type of DILI[OR=6.271,95%CI(1.443,27.253)].Conclusions DILI patients of the special endowment type are more likely to have cholestasis.Clinical treatment should be more cautious in selecting prescriptions and medications for patients of the special endowment type.Once DILI occurs,active treatment should be given to remove cholestasis and inhibit immunoinflammtory storm to prevent rapid progression of the disease in addition to timely withdrawal of drugs.