论文部分内容阅读
目的:分析新型冠状病毒肺炎（COVID-19）患者发生药物性肝损伤（DILI）的情况及其危险因素。方法:收集2020年1月15日至3月7日在长沙市第一医院出院的COVID-19患者的病历资料，根据DILI的诊断标准，将患者分为DILI组和非DILI组。记录并比较2组患者的一般情况，包括性别、年龄、基础疾病、COVID-19分型、入院时和用药后肝功能检测结果、用药情况、用药后出现DILI的时间、DILI的治疗和预后，计算COVID-19患者DILI的发生率，将组间比较n P<0.05的因素纳入多因素logistic回归分析，计算比值比（odds ratio，n OR）及其95%置信区间（confidence interval，n CI）。n 结果:共有203例COVID-19出院患者符合纳入标准，36例患者出现DILI，发生率为17.73 %。DILI组和非DILI组（167例）患者的性别分布，基础疾病为高血压、脂肪肝、胆石症者占比，COVID-19临床分型和用药种数的差异均有统计学意义（均n P0.05）；用药后DILI组ALT、AST水平均高于用药前，差异有统计学意义（均n P<0.001）。DILI组患者用药后出现DILI的中位时间为8（6，11）d，患者均无明显临床体征和症状。发生DILI后16例患者停用可疑药物并予以护肝治疗，6例仅停药未治疗，14例未停药但予护肝治疗；出院时36例患者中34例好转，2例肝功能未恢复至参考值范围。多因素logistic回归显示，男性（n OR=3.939，95n %CI：1.426~10.883，n P=0.008）、重型和危重型COVID-19（n OR=6.433，95n %CI：2.411~17.162，n P8种（n OR=10.181，95n %CI：3.606~28.744，n P8种是COVID-19患者发生DILI的独立危险因素。“,”Objective:To analyze the occurrence and risk factors of drug-induced liver injury (DILI) in patients with novel coronavirus pneumonia (COVID-19).Methods:The medical records of patients with COVID-19 who were discharged from the First Hospital of Changsha from January 15 to March 7, 2020 were collected and the patients were divided into the DILI group and the non-DILI group based on DILI diagnostic criteria. Basic information of patients in the 2 groups including gender, age, underlying diseases, classification of COVID-19, liver function test results on admission and after medication, drug use, time to DILI onset after medication, and treatments and outcomes of DILI were recorded and compared. The incidence of DILI in patients with COVID-19 was calculated, and the factors whose n P<0.05 in inter-group comparison were included in the multivariate logistic regression analysis to calculate the odds ratio (n OR) and95% confidence interval (n CI).n Results:A total of 203 discharged patients with COVID-19 met the inclusion criteria. Of them, 36 patients developed DILI, the incidence was 17.73%. Between the DILI group and the non-DILI group (167 patients), the differences were statistically significant in gender distribution, proportion of patients with underlying diseases such as hypertension, fatty liver, and cholelithiasis, clinical classification of COVID-19, and the kinds of drug use (n P0.05 for all). The levels of ALT and AST in patients in the DILI group after medication were higher than those before medication, and the differences were statistically significant (n P<0.001 for all). The median time for time to DILI onset after medication was 8 (6, 11) days and none of the patients had obvious clinical signs and symptoms. After the occurrence of DILI, 16 patients stopped the suspicious drugs and received liver-protective treatments, 6 patients only stopped the suspicious drug without additional treatments, and 14 patients received liver-protective treatments without drug withdrawal. Among the 36 patients in the DILI group, liver function were improved in 34 patients but did not returned to normal in 2 patients when they were discharged from the hospital. Multivariate logistic regression analysis showed that male (n OR=3.939, 95n %CI: 1.426-10.883, n P=0.008), being severe and critical in clinical classification (n OR=6.433, 95n %CI: 2.411-17.162, n P8 ( n OR=10.181, 95n %CI: 3.606-28.744, n P8 are the independent risk factors for DILI patients with COVID-19.