老年药物性肝损伤患者临床特征分析

姬琛华; 张竹青; 王晓媛; 卢书明

doi:10.3969/j.issn.1001-5256.2017.03.021

老年药物性肝损伤患者临床特征分析

DOI: 10.3969/j.issn.1001-5256.2017.03.021

1. 大连市中心医院消化内科
2. 大连市中心医院病理科
3. 大连医科大学附属第一医院消化内科

基金项目:

辽宁省自然科学基金资助项目(2015020324)；大连市卫生局课题；

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中图分类号: R575
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出版历程
- 出版日期: 2017-03-20

Clinical features of elderly patients with drug-induced liver injury

Department of Gastroenterology, Dalian Municipal Central Hospital

Research funding:

摘要

摘要:
目的分析老年药物性肝损伤（DILI）患者的临床特征。方法回顾性分析2010年1月-2015年12月于大连市中心医院及大连医科大学附属第一医院住院的老年和中青年DILI患者的临床资料,包括性别、年龄、基础疾病、导致肝损伤药物的种类、主要临床表现、肝功能指标（血清ALT、AST、ALP、GGT、Alb、TBil、DBil）、临床分型、治疗及转归等。计数资料2组间比较采用χ2检验,计量资料2组间比较采用Kolmogorov-Smirnov Z检验。结果 350例DILI患者中老年患者98例。老年组患者基础疾病前三位分别为心脑血管疾病（31.6%）、骨关节病（26.5%）、恶性肿瘤（18.4%）,其所占比例均明显高于中青年组（5.6%、6.3%、4.8%）,差异均有统计学意义（χ2值分别为42.825、27.214、16.667,P值均<0.001）,老年组患者感染性疾病所占比例明显低于中青年组（5.1%vs 29.4%,χ2=23.768,P<0.001）;引起肝损伤的药物中,老年组和中青年组应用最多的均为中药（5...
- 药物性肝损伤 /
- 老年人 /
- 诊断 /
- 疾病特征
Abstract:
Objective To investigate the clinical features of elderly patients with drug-induced liver injury (DILI) .Methods A retrospective analysis was performed for the clinical data of elderly and young and middle-aged patients with DILI who were hospitalized in Dalian Municipal Central Hospital and The First Affiliated Hospital of Dalian Medical University from January 2010 to December 2015, including sex, age, underlying diseases, drugs causing liver injury, main clinical manifestations, liver function parameters [serum levels of alanine aminotransferase (ALT) , aspartate aminotransferase, alkaline phosphatase (ALP) , gamma-glutamyl transpeptidase (GGT) , albumin, total bilirubin (TBil) , and direct bilirubin (DBil) ], clinical type, treatment, and prognosis.The chi-square test was used for comparison of categorical data between groups, and the Kolmogorov-Smirnov Z test was used for comparison of continuous data between groups.Results Among the 350 patients with DILI, there were 98 elderly patients (elderly group) .The three most common underlying diseases in the elderly group were cerebrovascular and cardiovascular diseases (31.6%) , osteoarthropathy (26.5%) , and malignant tumor (18.4%) , and the elderly group had significantly higher proportions of patients with these diseases than the young and middle-aged group (31.6%/26.5%/18.4% vs 5.6%/6.3%/4.8%, χ2=42.825, 27.214, and 16.667, all P<0.001) .Among the drugs causing liver injury, traditional Chinese medicine was applied most frequently in the elderly group and the young and middle-aged group (53.1% and44.4%, respectively) , and the elderly group had significantly higher proportions of patients using cardiovascular drugs or antitumor drugs than the young and middle-aged group (26.5%/9.2% vs 4.0%/3.2%, χ2=38.925 and 5.513, P<0.001 and P=0.026) .The elderly group had significantly higher proportions of patients with jaundice (53.1%) or pruritus (22.4%) than the young and middle-aged group (40.5%, 7.1%) (χ2=4.536 and 16.331, P=0.041 and P<0.001) .The most common clinical type in both groups was hepatocellular injury type;compared with the young and middle-aged group, the elderly group had a significantly lower proportion of hepatocellular injury type cases (60.2% vs 81.7%, χ2=17.807, P<0.001) and a significantly higher proportion of cholestasis type cases (28.6% vs 7.9%, χ2=25.389, P<0.001) .Compared with the young and middle-aged group, the elderly group had significantly lower levels of ALT and ALP and significantly higher levels of GGT, TBil, and DBil (Z=-3.141, -2.599, -7.449, -10.277, and-9.278, all P<0.01) .Three patients in the elderly group and one in the young and middle-aged group died during hospitalization.Conclusion Underlying diseases and drugs causing liver injury in elderly patients with DILI are different from those in young and middle-aged patients, and the elderly patients have a higher proportion of cholestasis type cases compared with the young and middle-aged patients.Therefore, prevention and treatment of DILI in elderly patients should be taken seriously.
- drug-induced liver injury /
- aged /
- diagnosis /
- disease attributes

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参考文献(14)

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