摘要： 目的 筛查视神经脊髓炎谱系疾病（NMOSDs）患者静脉注射甲泼尼龙（IVMP）诱发肝损伤危险因素。方法 回顾分析2017年1月至2021年12月在首都医科大学附属北京同仁医院行IVMP冲击治疗的195例NMOSDs患者临床资料，根据Roussel Uclaf因果关系评估法（RUCAM）评估IVMP与肝损伤间的因果关系，单因素和多因素逐步法Logistic回归分析筛查IVMP相关肝损伤的危险因素。结果 IVMP冲击治疗后14 d内，血清肝酶谱检测约32.31%（63/195）患者发生肝损伤[血清丙氨酸转氨酶（ALT）> 40 U/L，RUCAM评分 ≥ 3分]，重度肝损伤（ALT > 120 U/L）占15.87%（10/63）、轻度肝损伤占84.13%（53/63）。Logistic回归分析显示，年龄 ≥ 50岁（OR=0.969，95% CI：0.945~0.993；P=0.011）、免疫抑制剂应用史（OR=3.543，95% CI：1.579~7.949；P=0.002）和IVMP相关肝损伤史（OR=17.043，95% CI：3.400~85.423；P=0.000）是IVMP相关肝损伤的危险因素。结论 IVMP相关肝损伤以轻度肝损伤为主，年龄 ≥ 50岁、有免疫抑制剂应用史和IVMP相关肝损伤史的NMOSDs患者再次行IVMP冲击治疗易发生肝损伤。

关键词: 视神经脊髓炎, 甲泼尼龙, 化学性与药物性肝损伤, 危险因素, Logistic模型

Abstract: Objective To investigate the risk factors of liver injury in patients with neuromyelitis optica spectrum disorders (NMOSDs) after intravenous methylprednisolone (IVMP). Methods A total of 195 patients with NMOSDs who received IVMP in Beijing Tongren Hospital, Capital Medical University from January 2017 to December 2021 were enrolled. The causal relationship between IVMP and liver injury was evaluated according to Roussel Uclaf Causality Assessment Method (RUCAM). Univariate and multivariate stepwise Logistic regression analysis were used to screen the risk factors of IVMP related liver injury. Results Within 14 d after IVMP therapy, 32.31% (63/195) patients developed liver injury[serum alanine aminotransferase (ALT) > 40 U/L, RUCAM score ≥ 3]. Severe injury (ALT > 120 U/L) accounted for 15.87% (10/63) and mild injury 84.13% (53/63). Logistic regression analysis showed age ≥ 50 years old (OR=0.969, 95%CI:0.945-0.993; P=0.011), previous use of immunosuppressants (OR=3.543, 95%CI:1.579-7.949; P=0.002) and history of IVMP related liver injury (OR=17.043, 95%CI:3.400-85.423; P=0.000) were the main risk factors for IVMP related liver injury. Conclusions The main IVMP related liver injury is mild injury. NMOSDs patients aged ≥ 50 years old, previous use of immunosuppressants and history of IVMP related liver injury are more prone to liver injury when treated with IVMP again.

Key words: Neuromyelitis optica, Methylprednisolone, Chemical and drug induced liver injury, Risk factors, Logistic models