抗结核药物性肝损伤患者急性肝功能衰竭的影响因素分析

摘要/Abstract

摘要： 目的探讨抗结核药物性肝损伤患者的临床和实验室特点,确定急性肝功能衰竭(acute liver failure, ALF)的相关预测因素。方法选取2016年1月—2022年12月期间蒙城县第一人民医院诊治抗结核药物性肝损伤患者147例,根据是否存在ALF将患者分为ALF组和非ALF组,比较患者人口学特征、临床症状、实验室检查结果,并对ALF的相关危险因素进行单因素及多因素logistic回归分析。结果比较人口学特征可知,ALF组(n=52)既往肝炎病史的比例、治疗持续时间以及Hy’s定律阳性的比例分别为44.2%、51(7～328)d和51.9%,显著高于非ALF组(n=95)的18.9%、24(2～219)d和14.7%(P<0.05);比较临床症状和实验室检查结果可知,ALF组黄疸比例、恶心比例、腹水比例、腹胀比例、瘙痒比例、ALT水平、AST水平、ALP水平、TBil水平、DBLC水平、PT、WBC水平以及甲胎蛋白水平分别为90.4%、53.8%、42.3%、36.5%、23.1%、243(25, 2024)U/L、134(75, 1542)U/L、141(79, 530)U/L、265(27, 528)μmol/L、151(10, 289)μmol/L、18.5(3.1, 56.7)秒、6.1(2.8, 49.6)×10⁹/L和25.7(2.4, 1870)ng/mL, 显著高于非ALF组的20.0%、20.0%、13.7%、14.7%、10.5%、116(12, 724)U/L、88(27, 479)U/L、86(61, 646)U/L、14(6, 138)μmol/L、7(3, 102)μmol/L、12.2(9.8, 16.3)秒、5.2(2.1, 25.6)×10⁹/L和2.3(0.7, 3021.1)ng/mL(P<0.05);根据单因素logistic回归分析,AST水平、TBil水平、WBC水平、PLA水平、既往肝炎病史、PT、DBil水平、AFP水平、Alb水平、ALT水平、ALP水平、治疗持续时间、黄疸、腹胀、恶心、呕吐、瘙痒以及Hy’s定律阳性是抗结核药物治疗期间发生ALF的危险因素,根据多因素logistic回归分析,AST水平、TBL水平、WBC水平、PLA水平以及既往肝炎病史是ALF的强预测因子。结论高血清胆红素、WBC、既往肝炎病史、AST水平和低血小板计数是抗结核药物性肝损伤患者ALF的独立预测因素。

关键词: 药物性肝损伤, 急性肝功能衰竭, 危险因素

Abstract: Objective To explore the clinical and laboratory characteristics of patients with liver injury induced by anti-tuberculosis drugs, and to determine the predictive factors of acute liver failure (ALF). Methods A total of 147 patients with anti-tuberculosis drug-induced liver injury were divided into an ALF group and a non-ALF group based on the presence of acute liver failure between January 2016 and December 2022. Demographic characteristics, clinical symptoms, and laboratory results were compared between these two groups. Risk factors for the occurrence of acute liver failure were analyzed by univariate and multivariate logistic regression analysis. Results In the ALF group, there was a significantly higher incidence of previous hepatitis history, longer duration of treatment, and a greater proportion of Hy's 's law at 44.2%, 51 (73, 328) days and 51.9%, respectively, compared to 18.9%, 24 (219) days and 14.7% in the non-ALF group (P<0.05). Additionally, clinical symptoms and laboratory findings revealed that patients in the ALF group exhibited a significantly higher prevalence of jaundice, nausea, ascites, abdominal distension, pruritus, elevated levels of ALT, AST, ALP, total bilirubin, direct bilirubin, PT, WBC and alpha-fetoprotein [90.4%, 53.8%, 42.3%, 36.5%, 23.1%, 243 (25, 2024) U/L, 134 (75, 1542) U/L, 141 (79, 530) U/L, 265 (27, 528) μmol/L, 151 (10, 289) μmol/L, 18.5 (3.1, 56.7) s, 6.1 (2.8, 49.6)×10⁹/L and 25.7 (2.4, 1870) ng/mL] compared to the non-ALF group [20.0%, 20.0%, 13.7%, 14.7%, 10.5%, 116 (12, 724) U/L, 88 (27, 479) U/L, 86 (61, 646) U/L, 14 (6, 138) μmol/L, 7 (3, 102) μmol/L, 12.2 (9.8, 16.3) s, 5.2 (2.1, 25.6) ×10⁹/L and 2.3 (0.7, 3021.1) ng/mL] (P<0.05). Furthermore, the univariate logistic regression analysis identified AST level, TBil level, WBC count, PLA count, history of previous hepatitis, PT, DBil level, AFP level, Alb level, ALT level, ALP level, treatment duration, jaundice, abdominal distension, nausea, vomiting, pruritus, and a positive Hy's law as potential risk factors for the development of ALF during anti-tuberculosis therapy. Additionally, the multivariate logistic regression analysis indicated that AST level, TBil level, WBC count, PLA count, and history of previous hepatitis were strong predictors of ALF. Conclusion Elevated serum bilirubin, WBC count, AST level, low platelet count ,and a history of previous hepatitis are found to be independent predictors of acute liver failure in patients who have experienced liver injury due to anti-tuberculosis medications.

Key words: Drug-induced liver injury, Acute liver failure, Risk factor

张昭君, 刘跃. 抗结核药物性肝损伤患者急性肝功能衰竭的影响因素分析[J]. 肝脏, 2024, 29(5): 552-556.

ZHANG Zhao-jun, LIU Yue. Analysis of influencing factors of acute liver failure in 147 patients with liver injury induced by antituberculosis drugs[J]. Chinese Hepatolgy, 2024, 29(5): 552-556.

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