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[目的]探索肝功能损伤程度对职业性三氯乙烯药疹样皮炎(occupational medicamentosa-like dermatitis induced by trichloroethylene,OMDT)治愈率的可能影响。[方法]收集2012年1月—2016年6月入院接受诊疗的所有30名OMDT病例的病程和结局资料,用Cox回归模型分析病例住院期间检测到的血清总蛋白最低值(TPL)、白蛋白最低值(ALB_L)、总胆红素最高值(TBIL_M)、直接胆红素最高值(DBIL_M)、丙氨酸氨基转移酶活性最高值(ALT_M)、天门冬氨酸氨基转移酶活性最高值(AST_M)、谷氨酰转肽酶活性最高值(GGT_M)、碱性磷酸酶活性最高值(ALP_M)对OMDT治愈率的影响。[结果]30名OMDT病例病程中位数为108 d,截尾值占30.0%,总体治愈率为70.0%。所研究肝功能损伤程度指标间存在共线性。通过主成分分析,将前三个主成分代入Cox回归模型后发现,主要反映TP_L、ALB_L、TBIL_M、DBIL_M变异的主成分1是影响OMDT治愈率最重要的因素(RR=0.62,P<0.05)。Cox回归模型表达式显示,TP_L和ALB_L越高,TBIL_M、DBIL_M、ALT_M、AST_M、GGT_M、ALP_M越低,病例治愈率越高。[结论]肝功能损伤程度对OMDT的治愈率有影响,积极保护肝脏功能有助于提高病例的治愈率。
[Objective] To explore the possible influence of the degree of hepatic injury on the cure rate of occupational medicamentosa-like dermatitis induced by trichlorethylene (OMDT). [Methods] The course and outcome data of all 30 OMDT patients admitted to hospital from January 2012 to June 2016 were collected. The Cox regression model was used to analyze the serum total protein (TPL), albumin ALB_L, TBIL_M, DBIL_M, ALT_M, and aspartate aminotransferase activity were the highest ( AST_M), glutamyl transpeptidase activity (GGT_M), the highest alkaline phosphatase activity (ALP_M) on the cure rate of OMDT. [Results] The median duration of disease in 30 patients with OMDT was 108 days and the censored value was 30.0%. The overall cure rate was 70.0%. There is collinearity between the indexes of liver function damage studied. By principal component analysis, the first three principal components were substituted into the Cox regression model and found that the principal component 1 mainly reflecting the mutation of TP_L, ALB_L, TBIL_M and DBIL_M was the most important factor affecting the cure rate of OMDT (RR = 0.62, P <0.05) . Cox regression model showed that the higher TP_L and ALB_L, the lower the TBIL_M, DBIL_M, ALT_M, AST_M, GGT_M, ALP_M, the higher the cure rate. [Conclusion] The degree of liver injury has an effect on the cure rate of OMDT, and actively protecting the liver function can help to improve the cure rate of the cases.