阿托伐他汀药物性肝损伤的临床特征分析

Clinical Characteristics of Liver Injury Induced by Atorvastatin

背景药物性肝损伤是常见的药物不良反应之一,阿托伐他汀是临床上广泛应用的他汀类降脂药物之一,易引发肝损伤,目前对其所导致的药物性肝损伤的临床特征研究数据较少。目的探讨阿托伐他汀药物性肝损伤的临床特征,以提高临床医生对阿托伐他汀药物性肝损伤的认识。方法选取广西医科大学第一附属医院2012年1月—2022年8月住院且使用阿托伐他汀治疗,出现肝损伤且经Roussel Uclaf因果关系评估法评估为阿托伐他汀药物性肝损伤的患者,分析其临床特征。结果经Roussel Uclaf因果关系评估法评估,共确诊84例阿托伐他汀药物性肝损伤。阿托伐他汀药物性肝损伤患者中男性较多(72.6%),平均年龄为(60.2±11.5)岁,且均合并基础疾病(100.0%);达到中度肝损伤2例(2.4%),经治疗治愈或好转率达到100.0%。根据病程分型,主要表现为急性病程(100.0%);根据受损靶细胞分型以混合型最多(60.7%),其次是胆汁淤积型(26.2%)、肝细胞型(11.9%)。78.6%的患者服用阿托伐他汀发生肝损伤的时间在3个月内,且以第1~2周内居多;81.0%的患者在累积服用阿托伐他汀80个药物限定日剂量时发生肝损伤。结论阿托伐他汀药物性肝损伤多发生于男性、中老年、合并基础疾病的患者,多为轻度肝损伤,预后较好;临床分型以混合型、胆汁淤积型居多;肝损伤发生时间主要在3个月内,且阿托伐他汀药物性肝损伤的发生有一定剂量依赖性。

Background Drug-induced liver injury is one of the most common adverse drug reactions,and atorvastatin is one of the widely used statin lipid-lowering drugs in clinical practice,which is susceptible to hepatic injury.Currently,there is limited research data on the clinical characteristics of liver injury induced by atorvastatin.Objective To investigate the clinical characteristics of liver injury induced by atorvastatin,so as to improve clinicians'understanding of liver injury induced by atorvastation.Methods The patients who were hospitalized and treated with atorvastatin in the First Affiliated Hospital of Guangxi Medical University from January 2012 to August 2022,developed liver injury and were evaluated as liver injury induced by atorvastation based on Roussel Uclaf Causality Assessment Method were selected,and analyzed on clinical characteristics.Results A total of 84 cases of liver injury induced by atorvastation were diagnosed by Causality Assessment Method.The patients with liver injury induced by atorvastation were more male(72.6%),with an average age of(60.2±11.5)years,and all of them were comorbid with the underlying diseases(100.0%);two cases(2.4%)reached moderate liver injury,and the cure or improvement rate after treatment reached 100.0%.According to the stage of the disease,the main manifestation was an acute course(100.0%);according to the damaged target cells,the mixed type was the most frequent(60.7%),followed by the cholestasis type(26.2%)and the hepatocyte type(11.9%).The statistical results showed that 78.6%of the patients with liver injury occurred within 3 months after taking atorvastation and predominantly in the 1st to 2nd week;and 81.0%of the patients developed liver injuryat 80 defined daily dose(DDD)of cumulative atorvastation.Conclusion Liver injury induced by atorvastation occurs mostly in male,middle-aged and elderly patients patients with underlying diseases,mostly have mild liver injury and good prognosis,and the clinical types were mostly mixed type and cholestasis type.Liver injury occurs mainly within 3 months and the occurrence of liver injury induced by atorvastation was dose-dependent.