中国药物警戒 ›› 2023, Vol. 20 ›› Issue (2): 132-135.
DOI: 10.19803/j.1672-8629.20220660

• 中草药及抗肿瘤治疗相关肝损伤专栏（一） • 上一篇    下一篇

社区获得性肺炎患者抗生素相关性肝损伤外周血体液免疫特点分析

王宇1, 黄婧怡2, 侯立新1, 李爽1*, 崔永康1, 黄兰蔚1   

  1. 1上海市宝山区中西医结合医院消化科,上海 201999;
    2上海市宝山区中西医结合医院呼吸科,上海 201999
  • 收稿日期:2022-11-17 出版日期:2023-02-15 发布日期:2023-02-17
  • 通讯作者: *李爽,男,主任医师,中医药防治慢性肝病及消化道早癌防治。E-mail:15800647366@163.com
  • 作者简介:王宇,男,住院医师,中西医结合防治慢性肝病及脾胃病。
  • 基金资助:
    上海市卫生健康委员会科研项目（20214Y0236）

Humoral immune characteristics of peripheral blood of CAP patients with antibiotic-associated DILI

WANG Yu1, HUANG Jingyi2, HOU Lixin1, LI Shuang1*, CUI Yongkang1, HUANG Lanwei1   

  1. 1Department of Gastroenterology, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201999, China;
    2Department of Respiratory Medicine, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201999, China
  • Received:2022-11-17 Online:2023-02-15 Published:2023-02-17

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摘要： 目的 探究社区获得性肺炎（CAP）患者外周血中体液免疫指标与疗程中抗生素相关的药物性肝损伤（DILI）的关联性。方法 回顾性选择2021年6月1日至2022年6月30日上海市宝山区中西医结合医院收治的接受抗生素治疗的CAP患者共1 356例。以发生DILI为病例组,按照1∶2匹配未发生DILI的患者为对照组。收集患者的临床资料,分析2组之间的差异,并用多因素Logistic回归分析应用抗生素的CAP患者发生DILI的影响因素。结果 回顾性研究应用抗生素的CAP患者总数为1 356例,其中34例发生抗生素相关性DILI,其DILI发病率为2.5%。31例抗生素相关性DILI病例及对照组63例数据匹配成功,其中31例抗生素相关性DILI均为肝细胞损伤型。病例组与对照组在性别、年龄（±5岁）、主要诊断、病情程度（CURB-65评分）、合并基础疾病、疗程及剂量方面临床资料均衡可比,且饮食护理等具有一致性。2组在抗生素应用种类（青霉素类、头孢菌素类、碳青霉烯类、喹诺酮类、氨基糖苷类及大环内酯类）方面无显著差异。将外周血体液免疫指标、性别、年龄、CURB-65评分、抗生素纳入二元回归分析显示,免疫球蛋白G（IgG）与总免疫球蛋白E（IgE）为发生抗生素相关DILI的危险因素,具有统计学意义（P=0.028,P=0.038）。基于危险因素建立受试者工作特征（ROC）曲线的曲线下面积（AUC）分别为0.461(95%CI:0.336~0.587）和0.683(95%CI:0.560~0.806）,表明总IgE对抗生素相关性DILI的诊断具有可行的区分度。结论 体液免疫因素,尤其是总IgE异常升高可显著增加CAP患者发生抗生素相关性DILI的几率,表明适应性体液免疫可能参与了抗生素相关性DILI的发生。

关键词: 社区获得性肺炎, 药物性肝损伤, 抗生素, 体液免疫, 病例对照研究

Abstract: Objective To explore the correlations between humoral immune indexes of peripheral blood of patients with community acquired pneumonia (CAP) and drug-induced liver injury (DILI) associated with antibiotics during treatment. Methods A total of 1 356 patients with CAP who were treated with antibiotics between June 1, 2021 and June 30, 2022 in Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively selected. Patients with DILI were selected as the case group, while those without DILI were matched as the control group at the ratio of 1∶2. The clinical data of the patients were collected, the differences between the two groups were analyzed, and multivariate logistic regression was used to analyze the influencing factors of DILI in CAP patients receiving antibiotics. Results The total number of CAP patients receiving antibiotics during the retrospective study was 1 356, 34 of whom developed antibiotic-related DILI, so the incidence of DILI was 2.5%. The data on 31 cases of antibiotic-related DILI and 63 cases of the control group were successfully matched. The antibiotic-related DILI was of the hepatocyte injury type. The clinical data of the case group and the control group were balanced and comparable in terms of gender, age (±5 years), main diagnosis, severity of diseases (CURB-65 score), underlying diseases, treatment courses and doses, and diet and nursing were consistent. There was no significant difference in the types of antibiotics used (penicillin, cephalosporins, carbapenems, quinolones, aminoglycosides and macrolides) between the two groups. The humoral immune indexes of peripheral blood, gender, age, CURB-65 score, and antibiotics were included in binary regression analysis, and the results showed that IgG and total IgE were the risk factors for antibiotic-related DILI and were of statistical significance (P=0.028, P=0.038). The AUCs of ROC curves based on risk factors were 0.461 (95%CI: 0.336~0.587) and 0.683 (95%CI: 0.560-0.806), respectively, indicating that total IgE had a feasible discrimination for the diagnosis of antibiotic-related DILI. Conclusion Humoral immune factors, especially abnormal elevation of total IgE, can significantly increase the odds of antibiotic-related DILI in CAP patients, indicating that adaptive humoral immunity may be involved in the pathogenesis of antibiotic-related DILI.

Key words: community-acquired pneumonia, drug-induced liver injury, antibiotics, humoral immunity, case-control study

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