病情复发的慢性药物性肝损伤患者临床特征分析

Clinical characteristics of patients with recurrent chronic drug-induced liver injury:an analytical study

目的 分析病情复发的慢性药物性肝损伤患者临床特征。方法 回顾性分析2020年3月—2023年3月我院收治的265例慢性药物性肝损伤患者的临床资料,随访1年后根据是否复发分为复发组(n=33)和未复发组(n=232)。比较两组一般资料、实验室检查指标、肝组织学特征,分析慢性药物性肝损伤病情复发的临床特征,采用多因素logistic回归分析复发高危因素。结果 复发组、未复发组年龄分别为(44.2±7.9)岁、(40.8±7.5)岁,差异具有统计学意义(P<0.05)。复发组患者丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、γ-谷氨酰转肽酶及凝血酶原时间分别为(89.4±13.2)U/L、(87.2±12.5)U/L、(47.3±6.3)μmol/L、(105.4±15.4)U/L及(14.2±2.7)s,与未复发组[(37.5±7.1)U/L、(32.3±7.0)U/L、(15.2±2.0)μmol/L、(45.3±8.5)U/L及(12.6±2.3)s]比较差异有统计学意义(P<0.05)。相较于未复发组(9.9%、23.7%),复发组患者肝脏炎症程度、纤维化程度更严重(75.8%、36.3%,P<0.05)。多因素logistic回归分析结果显示,年龄、天冬氨酸氨基转移酶、总胆红素、γ-谷氨酰转肽酶、凝血酶原时间、胆碱酯酶、炎症程度、纤维化程度均为慢性药物性肝损伤病情复发的危险因素(OR=5.068、4.909、4.993、4.604、4.688、4.531、4.627、5.023,P<0.05)。结论 慢性药物性肝损伤病情复发时,患者多表现为高龄、多项实验室检查结果异常,肝脏炎症程度、纤维化程度严重,临床需对此类群体多加关注。

Objective To analyze the clinical characteristics of patients with recurrent chronic drug-induced liver injury.Methods A retrospective analysis was conducted on the clinical data of 265 patients with chronic drug-induced liver injury who were admitted to our hospital between March 2020 and March 2023.After a one-year follow-up,patients were categorized into two groups:a recurrent group(n=33)and a non-recurrent group(n=232),based on the presentce of recurrence.The study compared general informaion,laboratory examination indicators,and liver histological characteristics between the two groups to identify the clinical features associated with the recurrence of chronic drug-induced liver injury.Multivariate logistic regression was employed to analyze high-risk factors for recurrence.Results The mean ages of the recurrent and non-recurrent groups were 44.2±7.9 years and 40.8±7.5 years,respectively,with the difference being statistically significant(P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),γ-glutamyltranspeptidase(GGT),and prothrombin time(PT)in the recurrence group were 89.4±13.2 U/L,87.2±12.5 U/L,47.3±6.3μmol/L,105.4±15.4 U/L and 14.2±2.7 s.respectively.These are significantly higher compared to the non-recurrent group,which had ALT,AST,TBil,GGT.And PT values of 37.5±7.1 U/L,32.3±7.0 U/L,15.2±2.0μmol/L,45.3±8.5 U/L and 12.6±2.3 s,respectively(P<0.05).Additionally,the recurrent group exhibited more severe liver inflammation and fibrosis,with rates of 75.8%and 36.3%,compared to 9.9%and 23.7%in the non-recurrent groups,respectively(P<0.05).Multivariate logistic regression analysis identified age,AST,TBil,GGT,PT,cholinesterase,degree of inflammation,and degree of fibrosis as significant risk factors for the recurrence of chronic drug-induced liver injury(OR=5.068,4.909,4.993,4.604,4.688,4.531,4.627,5.023,P<0.05).Conclusion When chronic drug-induced liver injury recurs,patients typically present with advanced age,abnormal laboratory findings,and more severe liver inflammation,and fibrosis.This high-risk group warrants careful clinical attention.