中国药物警戒 ›› 2021, Vol. 18 ›› Issue (11): 1009-1013.
DOI: 10.19803/j.1672-8629.2021.11.03

• 药物性肝损伤科学评价与防控专栏 • 上一篇    下一篇

基于临床队列的药物性肝损伤慢性化表型特征研究

许文涛1, 王睿林1, 柏兆方2, 郭玉明2, 张帆3, 王伽伯2, 牛明2, 邹正升4, 肖小河2, 景婧1,*   

  1. 1解放军总医院第五医学中心肝病医学部中医肝病科,北京 100039;
    2解放军总医院第五医学中心肝病医学部肝病研究所,北京 100039;
    3深圳市第三人民医院肝病科,广东 深圳 518114;
    4解放军总医院第五医学中心肝病医学部肝病科,北京 100039
  • 收稿日期:2021-04-26 发布日期:2021-11-18
  • 通讯作者: *景婧,女,博士,副主任医师,中西医结合临床以及中草药致肝损伤的风险防控。E-mail：meg-forever@163.com
  • 作者简介:许文涛,男,硕士,主治医师,中西医结合临床。
  • 基金资助:
    国家自然科学基金资助项目（81874368,81630100,82074112）; 重大新药创制国家科技重大专项2018年度（2018ZX09101002-001-002）; 解放军总医院院内项目（2019-JQPY-003）; 解放军总医院大数据项目（2019MBD-045,2019MBD-023）

Chronic Phenotypes of Drug-induced Liver Injury Based on Clinical Cohort

XU Wentao1, WANG Ruilin1, BAI Zhaofang2, GUO Yuming2, ZHANG Fan3, WANG Jiabo2, NIU Ming2, ZOU Zhengsheng4, XIAO Xiaohe2, JING Jing1,*   

  1. 1Department of Traditional Chinese Medicine Hepatology, Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing 100039;
    2Institute of Hepatology, Department of Hepatology, the Fifth Medical Center of PLA General Hospital, Beijing, China 100039, China;
    3Department of Liver Disease, Shenzhen Third People's Hospital, Shenzhen Guangdong 518114, China;
    4Department of Hepatology, the Fifth Medical Center, PLA General Hospital, Beijing 100039, China
  • Received:2021-04-26 Published:2021-11-18

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摘要： 目的 评价分析药物性肝损伤（DILI）慢性化的不同临床表型及其特征。方法 回顾性分析符合研究条件的1 656例DILI住院患者,重点评价286例DILI慢性化病例的临床表型及其特征。结果 286例DILI慢性化患者中,男女比例为1∶1.92,中位年龄为49.03岁。根据肝功能动态变化和病情发展,DILI的慢性化可分为迁延不愈型（n=159, 55.6%）、反复发作型（n=31, 10.8%）、缓慢恢复型（n=27, 9.4%）、首次发现即为肝硬化型（n=69, 24.1%）。204例有详细用药信息,97.7%首次发病为肝硬化型DILI为2种及以上药物所致,其占比明显高于其他类型（P=0.015）。首次发病为肝硬化型与迁延不愈型较其他类型相比,终末期肝病模型（MELD）评分水平更高,预后更差（P<0.05）。结论 可将DILI慢性化过程分为4种类型,其中迁延不愈型为其主要临床表型,而首次发病为肝硬化型预后更差,临床上应予以高度关注。

关键词: 药物性肝损伤, 慢性化, 临床表型, 回顾性队列

Abstract: Objectiv eTo evaluate and analyze different clinical phenotypes and characteristics of chronic drug-induced liver injury (DILI). Methods The clinical data on 1 656 patients with DILI who met the inclusion criteria was retrospectively analyzed, and the clinical phenotypes and characteristics of 286 patients with chronic DILI were evaluated. Results The ratio of males to females was 1∶1.92, and the median age was 49.03 yrs. According to the dynamic changes of liver function and development of the disease, chronic DILI could be divided into the persistent type (n=159, 55.6%), recurrent type (n=31, 10.8%), slow recovery type (n=27, 9.4%), and first onset cirrhosis type (n=69, 24.1%). 204 of these cases were able to provide detailed information about medication. 97.7% of the cases of the first onset cirrhosis type were caused by two or more drugs, and the proportion was significantly higher than that of other types (P=0.015). Compared with other types, the MELD score of the first onset cirrhosis type was higher while the prognosis was worse (P<0.05). Conclusion The chronic process of DILI can be divided into four types, the main clinical phenotype of DILI is the persistent type, and the prognosis of the first onset of DILI of the cirrhosis type is poor, which deserves attention in clinic.

Key words: drug-induced liver injury, chronicity, clinical phenotype, retrospective cohort

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