基础疾病负担对药物性肝损伤严重程度及预后的影响

目的探讨基础疾病对药物性肝损伤(drug-induced liver injury,DILI)患者严重程度及预后的影响。方法纳入北京友谊医院肝病中心2016年1月至2019年12月符合入排标准的DILI患者,依据查尔森合并症指数(Charlson Comorbidity Index,CCI)分为显著基础疾病负担组(CCI>2分)和无或轻度基础疾病负担组(CCI≤2分),通过卡方检验及非参数检验分析两组患者临床特征、损伤程度及预后。结果313例DILI患者年龄为(54±14)岁,女性227例(72.5%),其中无或轻度基础疾病负担的患者272例(86.9%),显著基础疾病负担的患者41例(13.1%)。与无或轻度基础疾病负担组相比,显著基础疾病负担组年龄更大(63±8)岁比(52±14)岁]、体质指数(24.2±5.2)比(23.1±3.6)kg/m²]及谷氨酰转肽酶初始值283.0(159.0,404.0)U/L比189.0(100.0,325.0)U/L;峰值335.0(239.0,582.0)U/L比219.0(131.0,360.0)U/L]更高,差异均有统计学意义(均P<0.01);严重程度及临床分型两组相比差异无统计学意义(P>0.05)。在本队列中,250例(79.9%)DILI患者恢复正常,41例(13.1%)发展为慢性DILI,22例(7.0%)需要肝移植或者死亡,显著基础疾病负担组全因病死率及非肝脏相关的病死率均显著高于无或轻度基础病负担组患者(19.5%比3.7%;12.2%比0.7%,均P<0.01)。结论基础疾病负担重的患者预后差,以非肝脏相关死亡为主。

Influence of comorbidity on severity and prognosis of patients with DILI

Objective To investigate the influence of comorbidity on severity and prognosis of patients with drug-induced liver injury(DILI).Methods DILI patients admitted to our hospital from January 2016 to December 2019 who met the inclusion criteria were enrolled.According to Charlson Comorbidity Index(CCI),they were divided into significant comorbidity group(CCI≤2)and none or mild comorbidity group(CCI>2).The clinical characteristics,severity and prognosis between the 2 groups were analyzed by chi-square or non-parametric test.Results A total of 313 DILI patients were included,with an average age of 54±14 years,227 of them were females(72.5%).There were 272 patients with mild or without comorbidity(86.9%)and 41 patients with significant comorbidity(13.1%).Compared with patients with mild or without comorbidity,patients with significant comorbidity were significantly older(63±8 vs 52±14),and had higher body mass index(24.2±5.2 vs 23.1±3.6),higher gamma-glutamyl transferase(GGT)level initial value:283.0(159.0-404.0)vs 189.0(100.0-325.0),higher peak value335.0(239.0-582.0)vs 219.0(131.0-360.0)](all P<0.05).There was no significant difference in severity and clinical classification between 2 groups.In this cohort,250(79.9%)patients were fully recovered,whereas 41(13.1%)patients developed to chronic DILI and 22(7.0%)patients underwent liver transplantation or death.Compared to none or mild comorbidity group,the all-cause mortality and non-liver related mortality were significant higher in significant comorbidity group(19.5%vs 3.7%;12.2%vs 0.7%all P<0.01).Conclusion Patients with significant comorbidity had poor prognosis,the leading cause of death is non-liver related.