32例药物性肝损伤肝衰竭患者影响因素分析及预后评价

Analysis of influencing factors and prognosis of 32 patients with drug-induced liver injury and liver failure

目的探讨药物性肝损伤(DILI)患者发生药物性肝损伤肝衰竭(DILF)的危险因素,并对预后情况进行分析。方法选取2015年1月-2022年12月期间南通市肿瘤医院收治的DILI和肝衰竭患者,其中DILI 221例,男性97例、女性124例,年龄46(37,60)岁;DILF 32例,男性17例、女性15例,年龄47(40,58)。比较DILI、DILF患者以及不同临床结局DILF患者临床资料,运用多因素分析探讨影响DILI患者肝衰竭发生以及DILF预后不良的危险因素。结果DILI患者用药情况具体为中药/中成药120例(54.3%)、抗结核药物37例(16.7%)、感冒药29例(13.1%)、抗肿瘤药物11例(5.0%)、降血脂药物7例(3.2%)、抗甲状腺药物5例(2.3%)、神经精神类药物4例(1.8%)及其他药物8例(3.6%);DILF患者用药情况具体为抗结核药物14例(43.7%)、中药/中成药12例(37.5%)、感冒药2例(6.2%)以及抗肿瘤药物、免疫调节剂、精神类药物、降血压药各1例(3.1%)。单因素分析得出DILI患者HBV感染、抗结核药物、WBC、AST、TBil、血氨、INR及MELD评分低于DILF患者,而DILI患者PLT、PTA高于DILF患者,两组比较差异有统计学意义(P<0.05)。将肝功能、凝血功能等反映肝损伤严重程度的指标除外,多因素分析提示HBV感染、WBC升高及PLT减少为DILI发生肝衰竭的独立危险因素(P<0.05)。DILF患者系统治疗后好转、恶化病例分别为14例、18例。单因素分析得出好转、恶化DILF患者ALT、TBil、Scr、PTA、INR、MELD评分等比较,差异具有统计学意义(P<0.05)。多因素分析提示低PTA是DILF患者预后不良的独立危险因素(P<0.05)。结论DILI患者发生肝衰竭存在着多项危险因素,包括WBC升高及PLT减少。HBV感染病例服用抗结核药、中药/中成药等高风险致肝损伤药物时,需要警惕AILF的发生。另外,AILF患者存在凝血功能异常时,往往预后较差。

Objective To explore the risk factors and prognosis of drug-induced liver injury(DILI)and liver failure(DILF).Methods Between January 2015 and December 2022,hospitalized patients in Nantong Cancer Hospital who were diagnosed with DILI or DILF were enrolled.There were 221 patients with DILI[97 males,124 females;age=46(37,60)years]and 32 cases of DILF[17 males,15 females,age=47(40,58)years].The clinical data of DILI,DILF and DILF patients with different clinical outcomes were compared.Multivariate analysis was used to explore the risk factors and poor prognosis of liver failure.Results The drug use of DILI patients included 120 cases of traditional Chinese medicines/proprietary Chinese medicines(54.3%),37 cases of anti-tuberculosis drugs(16.7%),29 cases of cold drugs(13.1%),11 cases of anti-tumor drugs(5.0%),7 cases of hypolipidemic drugs(3.2%),5 cases of antithyroid drugs(2.3%)and neuropsychiatric drugs.The drug use of DILF patients included 14 cases of anti-tuberculosis drugs(43.7%),12 cases of traditional Chinese medicine/proprietary Chinese medicine(37.5%),2 cases of cold drugs(6.2%),and 1 case of anti-tumor drugs,immunomodulators,psychotropic drugs and antihypertensive drugs(3.1%).Univariate analysis showed that the scores of HBV infection,anti-tuberculosis drugs,WBC,AST,TBil,blood ammonia,INR and MELD in patients with DILI were significantly lower than those in patients with DILF,while PLT and PTA in patients with DILI were significantly higher than those in patients with DILF(P<0.05).Excluding indicators that reflect the severity of liver injury such as liver function,coagulation function and other indicators,multivariate analysis showed that HBV infection,increased WBC and decreased PLT were independent risk factors for DILF(P<0.05).After systemic treatment,14 patients with DILF improved and 18 patients deteriorated.Univariate analysis indicated that the differences in ALT,TBil,Scr,PTA,INR and MELD scores between patients with DILF who improved and those who deteriorated were statistically significant(P<0.05).Multivariate analysis showed that low PTA was an independent risk factor for poor prognosis of DILF patients(P<0.05).Conclusion There are many risk factors for patients with DILF,including increased WBC and decreased PLT.When HBV-infected patients take anti-tuberculosis drugs,traditional Chinese medicine/Chinese patent medicine and other high-risk drugs causing liver injury,they need to be alert to the occurrence of AILF.In addition,patients with AILF often have poor prognoses when they have abnormal coagulation function.