中国药物警戒 ›› 2023, Vol. 20 ›› Issue (5): 505-510.
DOI: 10.19803/j.1672-8629.20220718

• 中草药及抗肿瘤治疗相关肝损伤专栏（二） • 上一篇    下一篇

113例抗肿瘤药物相关肝损伤的临床特点及危险因素分析

李容容1, 李盟1, 苟悦1, 罗琼1, 吕桦2, 孙鑫1,3, 刘成海1,3,4,*   

  1. 1上海中医药大学附属曙光医院肝病研究所,上海 201203;
    2上海中医药大学附属曙光医院中医医院医疗质量监测中心,上海 201203;
    3上海市中医临床重点实验室,上海 201203;
    4肝肾疾病病证教育部重点实验室,上海 201203
  • 收稿日期:2022-12-12 出版日期:2023-05-15 发布日期:2023-05-16
  • 通讯作者: *刘成海,男,博士,主任医师,教授·博导,肝脏疾病的中西医结合防治。E-mail: chenghailiu@hotmail.com
  • 作者简介:李容容,女,在读博士,中西医结合防治急慢性药物性肝病。
  • 基金资助:
    上海市中医药事业发展三年行动计划[ZY(2018-2020)-CCCX-5001]; 上海市科学技术委员会科技计划项目(20Z21900100); 上海市临床重点专科建设项目(shslczdzk01201)

Clinical characteristics and risk factors of 113 cases of anti-neoplastic drug-induced liver injury

LI Rongrong1, LI Meng1, GOU Yue1, LUO Qiong1, LYU Hua2, SUN Xin1,3, LIU Chenghai1,3,4,*   

  1. 1Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
    2Medical Quality Monitoring Center of TCM Hospital, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
    3Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Shanghai 201203, China;
    4Key Laboratory of Liver and Kidney Diseases, Ministry of Education, Shanghai 201203, China
  • Received:2022-12-12 Online:2023-05-15 Published:2023-05-16

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摘要： 目的 分析抗肿瘤药物所致药物性肝损伤（DILI）的临床特点及危险因素。方法 回顾性分析上海中医药大学附属曙光医院2021年1月1日至2022年6月30日接受抗肿瘤药物治疗致DILI的113例患者临床资料,包括性别、年龄、个人史、原发肿瘤部位、抗肿瘤治疗方案、血常规、肝肾功能、肿瘤指标等。采用χ2检验、t检验和非参数检验（两独立样本检验）进行分析。结果 113例抗肿瘤药物致DILI患者中,男女比例1.13∶1,55岁以上老年患者居多。在肿瘤原发部位方面,结肠癌（25.7%）、肺癌（13.3%）、胃癌（12.4%）患者抗肿瘤治疗中发生DILI较多。抗肿瘤治疗方案中以化学治疗及靶向联合化疗的治疗方案导致DILI最多见。DILI的临床分型中胆汁淤积型患者比例最高（107例,94.7%）,混合型次之（6例,5.3%）;在肝损伤程度方面以轻度肝损伤为主（107例,94.7%）。Logistic回归分析显示,饮酒（OR 4.336,P=0.042）是抗肿瘤药物诱导DILI发生的独立危险因素。结论 抗肿瘤药物致DILI多发生于老年患者,以化疗及靶向联合化疗方案最常见,临床表现以胆汁淤积型为主,肝损伤程度较轻,饮酒史是重要风险因素。

关键词: 肿瘤, 抗肿瘤药物, 药物性肝损伤, 胆汁淤积型, 化疗, 靶向联合化疗, 临床特点, 危险因素, 饮酒

Abstract: Objective To analyze the clinical characteristics of anti-neoplastic drug induced liver injury (DILI). Methods The clinical data of 113 patients with DILI during anti-neoplastic therapy in Shuguang Hospital Affiliated to Shanghai University of TCM from January 1, 2021 to June 30, 2022 was retrospectively analyzed, including gender, age, disease history, primary tumor sites, anti-neoplastic therapy regimens, blood routine, liver and kidney function and tumor indicators. Chi-square test, t test and nonparametric test were used for analysis. Results Among the 113 patients with antitumor DILI, the ratio of males to females was 1.13∶1, and most of them were over 55 years old. In terms of primary tumor sites, the incidence of DILI was higher in patients with colon cancer (25.7%), lung cancer (13.3%), and gastric cancer (12.4%). Among antitumor therapy regimens, chemotherapy and targeted combined chemotherapy were most likely to cause DILI. As for the clinical classification of DILI, the proportion of patients with cholestasis was the highest (107 cases, 94.7%), followed by the mixed type (6 cases, 5.3%). The degree of liver injury was mostly mild (107 cases, 94.7%). Logistic regression analysis showed that alcohol consumption (OR 4.336, P=0.042) was an independent risk factor for antitumor DILI. Conclusion DILI caused by anti-neoplastic drugs mostly occur in elderly patients, and chemotherapy and targeted combination chemotherapy are the most common. Cholestasis is the dominating type. The degree of liver injury is relatively mild, and a previous history of alcohol consumption increases the risk of anti-neoplastic DILI.

Key words: tumor, anti-neoplastic drug, drug-induced liver injury(DILI), cholestatic, chemotherapy, targeted combination chemotherapy, clinical characteristics, risk factors, alcohol consumption

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