Q Wei, L Li, X Q Zeng, Bai He Ti Ya Er Abidan, J Yin, H Gao, J S Guo
{"title":"[药物性肝损伤患者的临床特征和预后相关风险因素分析]。","authors":"Q Wei, L Li, X Q Zeng, Bai He Ti Ya Er Abidan, J Yin, H Gao, J S Guo","doi":"10.3760/cma.j.cn501113-20240201-00072","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objective:</b> To explore the drugs and clinical characteristics causing drug-induced liver injury (DILI) in recent years, as well as identify drug-induced liver failure, and chronic DILI risk factors, in order to better manage them timely. <b>Methods:</b> A retrospective investigation and analysis was conducted on 224 cases diagnosed with DILI and followed up for at least six months between January 2018 and December 2020. Univariate and multivariate logistic regression analyses were used to identify risk factors for drug-induced liver failure and chronic DILI. <b>Results:</b> Traditional Chinese medicine (accounting for 62.5%), herbal medicine (accounting for 84.3% of traditional Chinese medicine), and some Chinese patent medicines were the main causes of DILI found in this study. Severe and chronic DILI was associated with cholestatic type. Preexisting gallbladder disease, initial total bilirubin, initial prothrombin time, and initial antinuclear antibody titer were independent risk factors for DILI. Prolonged time interval between alkaline phosphatase (ALP) and alanine aminotransferase (ALT) falling from the peak to half of the peak (T(0.5ALP) and T(0.5ALT)) was an independent risk factor for chronic DILI [area under the receiver operating characteristic curve (AUC) = 0.787, 95%CI: 0.697~0.878, <i>P</i> < 0.001], with cutoff values of 12.5d and 9.5d, respectively. <b>Conclusion:</b> Traditional Chinese medicine is the main contributing cause of DILI. The occurrence risk of severe DILI is related to preexisting gallbladder disease, initial total bilirubin, prothrombin time, and antinuclear antibodies. T(0.5ALP) and T(0.5ALT) can be used as indicators to predict chronic DILI.</p>","PeriodicalId":24006,"journal":{"name":"中华肝脏病杂志","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[An analysis on clinical characteristics and prognosis-related risk factors in patients with drug-induced liver injury].\",\"authors\":\"Q Wei, L Li, X Q Zeng, Bai He Ti Ya Er Abidan, J Yin, H Gao, J S Guo\",\"doi\":\"10.3760/cma.j.cn501113-20240201-00072\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Objective:</b> To explore the drugs and clinical characteristics causing drug-induced liver injury (DILI) in recent years, as well as identify drug-induced liver failure, and chronic DILI risk factors, in order to better manage them timely. <b>Methods:</b> A retrospective investigation and analysis was conducted on 224 cases diagnosed with DILI and followed up for at least six months between January 2018 and December 2020. Univariate and multivariate logistic regression analyses were used to identify risk factors for drug-induced liver failure and chronic DILI. <b>Results:</b> Traditional Chinese medicine (accounting for 62.5%), herbal medicine (accounting for 84.3% of traditional Chinese medicine), and some Chinese patent medicines were the main causes of DILI found in this study. Severe and chronic DILI was associated with cholestatic type. Preexisting gallbladder disease, initial total bilirubin, initial prothrombin time, and initial antinuclear antibody titer were independent risk factors for DILI. Prolonged time interval between alkaline phosphatase (ALP) and alanine aminotransferase (ALT) falling from the peak to half of the peak (T(0.5ALP) and T(0.5ALT)) was an independent risk factor for chronic DILI [area under the receiver operating characteristic curve (AUC) = 0.787, 95%CI: 0.697~0.878, <i>P</i> < 0.001], with cutoff values of 12.5d and 9.5d, respectively. <b>Conclusion:</b> Traditional Chinese medicine is the main contributing cause of DILI. The occurrence risk of severe DILI is related to preexisting gallbladder disease, initial total bilirubin, prothrombin time, and antinuclear antibodies. T(0.5ALP) and T(0.5ALT) can be used as indicators to predict chronic DILI.</p>\",\"PeriodicalId\":24006,\"journal\":{\"name\":\"中华肝脏病杂志\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"中华肝脏病杂志\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3760/cma.j.cn501113-20240201-00072\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"中华肝脏病杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/cma.j.cn501113-20240201-00072","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的探讨近年来导致药物性肝损伤(DILI)的药物和临床特征,并识别药物性肝衰竭和慢性 DILI 的危险因素,以便更好地及时处理。研究方法对2018年1月至2020年12月期间确诊为DILI并随访至少6个月的224例病例进行回顾性调查分析。采用单变量和多变量逻辑回归分析确定药物性肝衰竭和慢性DILI的风险因素。结果显示本研究发现,中药(占 62.5%)、中草药(占中药的 84.3%)和一些中成药是导致 DILI 的主要原因。严重和慢性 DILI 与胆汁淤积型有关。原有胆囊疾病、初始总胆红素、初始凝血酶原时间和初始抗核抗体滴度是导致 DILI 的独立危险因素。碱性磷酸酶(ALP)和丙氨酸氨基转移酶(ALT)从峰值下降到峰值一半的时间间隔(T(0.5ALP)和T(0.5ALT))延长是慢性DILI的独立危险因素[接收器操作特征曲线下面积(AUC)=0.787,95%CI:0.697~0.878,P 结论:中药是导致慢性DILI的主要原因:中药是导致 DILI 的主要原因。严重 DILI 的发生风险与胆囊疾病、初始总胆红素、凝血酶原时间和抗核抗体有关。T(0.5ALP)和T(0.5ALT)可作为预测慢性 DILI 的指标。
[An analysis on clinical characteristics and prognosis-related risk factors in patients with drug-induced liver injury].
Objective: To explore the drugs and clinical characteristics causing drug-induced liver injury (DILI) in recent years, as well as identify drug-induced liver failure, and chronic DILI risk factors, in order to better manage them timely. Methods: A retrospective investigation and analysis was conducted on 224 cases diagnosed with DILI and followed up for at least six months between January 2018 and December 2020. Univariate and multivariate logistic regression analyses were used to identify risk factors for drug-induced liver failure and chronic DILI. Results: Traditional Chinese medicine (accounting for 62.5%), herbal medicine (accounting for 84.3% of traditional Chinese medicine), and some Chinese patent medicines were the main causes of DILI found in this study. Severe and chronic DILI was associated with cholestatic type. Preexisting gallbladder disease, initial total bilirubin, initial prothrombin time, and initial antinuclear antibody titer were independent risk factors for DILI. Prolonged time interval between alkaline phosphatase (ALP) and alanine aminotransferase (ALT) falling from the peak to half of the peak (T(0.5ALP) and T(0.5ALT)) was an independent risk factor for chronic DILI [area under the receiver operating characteristic curve (AUC) = 0.787, 95%CI: 0.697~0.878, P < 0.001], with cutoff values of 12.5d and 9.5d, respectively. Conclusion: Traditional Chinese medicine is the main contributing cause of DILI. The occurrence risk of severe DILI is related to preexisting gallbladder disease, initial total bilirubin, prothrombin time, and antinuclear antibodies. T(0.5ALP) and T(0.5ALT) can be used as indicators to predict chronic DILI.