肠外营养致肝功能异常的主动监测和危险因素分析

Risk factors and active surveillance for abnormal liver function induced by parenteral nutrition

目的探索肠外营养所致肝功能异常在胃肠道恶性肿瘤患者中的发生率、临床特点及危险因素,降低临床用药风险。方法通过中国医院药物警戒系统(CHPS)搜索2022年7月1日—12月31日在南华大学附属第二医院使用肠外营养治疗的胃肠道恶性肿瘤患者,病例组为CHPS中触发警报信号指示肝功能异常且经药师审核的患者,在未触发警报信号的患者中,剔除重复入院患者得到对照组,分析肝功能异常的发生情况,采用二元Logistic回归分析筛选潜在风险因素。结果肠外营养所致肝功能异常在胃肠道恶性肿瘤患者的发生率为4.98%;85%发生在用药后5~10 d,以轻度转氨酶升高为主要表现。二元Logistic回归分析显示败血症、合并脂肪乳是肠外营养致肝功能异常的独立危险因素(P<0.05)。结论本研究通过CHPS开展药品不良反应主动监测,可反映肠外营养所致肝功能异常在胃肠道恶性肿瘤患者的发生情况,为临床安全用药提供参考。

Objective To determine the incidence,clinical characteristics and risk factors of abnormal liver function related to parenteral nutrition in patients with gastrointestinal malignancies,and reduce the risks of clinical drug use.Methods Patients with gastrointestinal malignancies admitted to our hospital between July 1st and December 31st,2022,and treated with parenteral nutrition were monitored with the China Hospital Pharmacovigilance System(CHPS).The experimental group comprised patients who had abnormal liver function and checked by pharmacists after CHPS alarm signals were triggered.The control group consisted of patients who did not trigger the alarm signals,with re-admitted patients being excluded.Binary Logistic regression analysis was conducted to analyze the risk factors for abnormal liver function.Results The incidence of abnormal liver function related to parenteral nutrition in patients with gastrointestinal malignancies was 4.98%.Dysfunction occurred in approximately 85%of patient cases within 5 to 10 days after the treatment,with mild elevation of transaminase as the main manifestation.Binary Logistic regression analysis showed that sepsis and combined fat emulsion were independent risk factors with statistical difference(P<0.05).Conclusion Active monitoring of adverse drug reactions by CHPS can reveal the occurrence of abnormal liver function related to parenteral nutrition in patients with gastrointestinal malignancies.