解放军总医院第五医学中心2009年-2019年老年药物性肝损伤患者的临床特征及变化趋势

王丽苹; 何婷婷; 崔延飞; 王仲霞; 景婧; 王立福; 朱云; 孙永强; 许文涛; 余思邈; 桑秀秀; 田淼; 任岳波; 王睿林

doi:10.3969/j.issn.1001-5256.2020.10.017

解放军总医院第五医学中心2009年-2019年老年药物性肝损伤患者的临床特征及变化趋势

DOI: 10.3969/j.issn.1001-5256.2020.10.017

1. 解放军总医院第五医学中心中医科
2. 解放军总医院第五医学中心中西医结合科
3. 河南中医药大学第一附属医院脾胃肝胆科

基金项目:

国家自然科学基金资助项目(81673806)；保健专项科研课题(17BJZ53)；

详细信息

中图分类号: R575
计量
- 文章访问数: 1288
- HTML全文浏览量: 57
- PDF下载量: 102
- 被引次数: 0
出版历程
- 收稿日期: 2020-03-23
- 出版日期: 2020-10-20

Clinical features and changing trend of elderly patients with drug-induced liver injury in The Fifth Medical Center of Chinese PLA General Hospital from 2009 to 2019

Department of Traditional Chinese Medicine, The Fifth Medical Center of Chinese PLA General Hospital
Department of Integrated Traditional Chinese and Western Medicine,The Fifth Medical Center of Chinese PLA General Hospital
Department of Hepatology and Spleen - Stomach,The First Affiliated Hospital of Henan University of Traditional Chinese Medicine

Research funding:

摘要

摘要: 目的了解老年药物性肝损伤（DILI）的疾病特征及变化趋势,为临床防治老年DILI提供参考。方法回顾纳入解放军总医院第五医学中心2009年1月-2019年12月期间明确诊断为DILI且年龄≥60岁的老年DILI患者2107例,按年龄分段进行分组,统计分析老年DILI患者的年龄、性别、临床特征、预后、地区分布等临床资料。计数资料组间比较采用χ2检验。结果 2107例老年DILI患者中,男802例,女1305例,男女比为1∶1.63。临床分型以胆汁淤积型为主（1439例,68.3%）。60～64岁组DILI患者最多,共942例（44.7%）,其中女618例（65.6%）,胆汁淤积型589例（62.5%）,以慢性DILI多见（471例,50.0%）,药物性肝硬化421例（44.7%）,药物性肝衰竭25例（2.7%）。75～79岁组共187例,其中男110例（58.8%）,胆汁淤积型137例（73.3%）,以肝硬化多见（114例,60.9%）,药物性肝衰竭4例（2.1%）。60～64岁组以慢性DILI多见,75～79岁组以肝硬化多见。在预后方面,60～64岁组治愈27例（2.9%）,好转885例...
- 化学性与药物性肝损伤 /
- 体征和症状 /
- 老年人
Abstract: Objective To investigate the features and changing trend of drug-induced liver injury( DILI) in the elderly from 2009 to2019,and to provide a reference for clinical prevention and treatment of DILI in the elderly. Methods A retrospective analysis was performed for the clinical data of 2107 elderly patients,aged ≥60 years,who were diagnosed with DILI in The Fifth Medical Center of Chinese PLA General Hospital from January 2009 to December 2019,and they were divided into groups according to age. Related clinical data were analyzed,including age,sex,clinical features,prognosis,and regional distribution. The Chi-square test was used for comparison of categorical data between groups. Results Among the 2107 patients with DILI,there were 802 male patients and 1305 female patients,with a male/female ratio of 1∶ 1. 63. Cholestasis type was the most common clinical type and was observed in 1439 patients( 68. 3%). There was the highest number of patients in the 60-64 years group( 942 patients,44. 7%),among whom 618( 65. 6%) were female,589( 62. 5%)had cholestasis type,471( 50. 0%) had chronic DILI,421( 44. 7%) had drug-induced liver cirrhosis,and 25( 2. 7%) had drug-induced liver failure. There were 187 patients in the 75-79 years group,among whom 110( 58. 8%) patients were male,137( 73. 3%) had cholestasis type,114( 60. 9%) had liver cirrhosis,4( 2. 1%) had drug-induced liver failure. The results showed that chronic DILI was more common in the 60-64 years group,and liver cirrhosis was more common in the 75-79 years group. As for prognosis,in the 60-64 years group,27 patients( 2. 9%) were cured,885( 93. 9%) were improved,30( 3. 2%) had no response or died; in the 65-69 years group,16( 2. 8%) were cured,528( 92. 0%) were improved,and 30( 5. 2%) had no response or died; in the 70-74 years group,9( 2. 8%) were cured,305( 94. 1%) were improved,and 10( 3. 6%) had no response or died. The results showed that there was no significant difference in mortality rate between the different age groups( P > 0. 05). The proportion of elderly DILI patients among hospitalized DILI patients increased from 15. 90% in 2009 to 22. 05% in 2013 and 27. 51% in 2019,with a 1. 73-fold increase in 11 years. As for regional distribution,the patients in North China accounted for the highest proportion of 47. 08%( the patients from Hebei,Shanxi,and Inner Mongolia accounted for 24. 92%,10. 96%,and 10. 25%,respectively),followed by those in Northeast China who accounted for 17. 85%.The patients in Beijing accounted for 11. 53%. Conclusion The proportion of elderly DILI patients among hospitalized DILI patients tends to increase in these years. Cholestasis type is the most common clinical type,and most of the patients with this clinical type progress to chronic DILI and drug-induced liver cirrhosis. Early diagnosis,early intervention,and standardized treatment of elderly DILI should be taken seriously.
- chemical and drug induced liver injury /
- signs and symptoms /
- aged

HTML全文

参考文献(15)

[1] Drug-induced Liver Disease Study Group,Chinese Society of Hepatology,Chinese Medical Association. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol,2015,31(11):1752-1769.(in Chinese)中华医学会肝病学分会药物性肝病学组．药物性肝损伤诊治指南[J]．临床肝胆病杂志，2015,31(11):1752-1769.

[2] LEE WM. Drug-induced acute liver failure[J]. Clin Liver Dis,2013,17(4):575-586.

[3] DANAN G,BENICHOU C. Causality assessment of adverse reactions to drug-I. A novel method based on the conclusions of international consensus meetings:Application to drug-induced liver injury[J]. Clin Epidemiol,1993,46(11):1323-1330.

[4] Branch of Hepatobiliary Diseases,China Association of Chinese Medicine,Branch of Chinese Patent Medicine,China Association of Chinese Medicine. Guidelines for the clinical management of herb-induced liver injury[J]. J Clin Hepatol,2016,32(5):835-843.(in Chinese)中华中医药学会肝胆病分会，中华中医药学会中成药分会．中草药相关肝损伤临床诊疗指南[J]．临床肝胆病杂志，2016,32(5):835-843.

[5] Chinese Society of Hepatology,Chinese Medical Association.Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol,2019,35(11):2408-2425.(in Chinese)中华医学会肝病学分会．肝硬化诊治指南[J]．临床肝胆病杂志，2019,35(11):2408-2425.

[6] Liver Failure and Artificial Liver Group,Chinese Society of Infectious Diseases,Chinese Medical Association; Severe Liver Disease and Artificial Liver Group,Chinese Society of Hepatology,Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol,2019,35(1):38-44.(in Chinese)中华医学会感染病学分会肝衰竭与人工肝学组，中华医学会肝病学分会重型肝病与人工肝学组．肝衰竭诊治指南(2018年版)[J]．临床肝胆病杂志，2019,35(1):38-44.

[7] GUO Y,FAN Y,QIU J,et al. Polymorphisms in CTLA4 influence incidence of drug-induced liver injury after renal transplantation in Chinese recipients[J]. PLo S One, 2012,7(12):e51723.

[8] XU LN,LI Y,PENG JY. microRNA and drug-induced liver injury[J]. Chin J Clin Pharmacol Ther,2020,25(7):803-809.(in Chinese)许丽娜，李月，彭金咏．microRNA与药物性肝损伤[J]．中国临床药理学与治疗学，2020,25(7):803-809.

[9] TENG GJ,LI BS,ZHAO J,et al. Characteristics and change trend of drug-induced liver injury in recent 10 years[J]. Chin Hepatol,2014,19(5):329-331.(in Chinese)腾光菊，李保森，赵军，等．近10年药物性肝损伤患者的特点及变化趋势[J]．肝脏，2014,19(5):329-331.

[10] CHO J,KIM L,LI Z,et al. Sex bias in experimental immunemediated,drug-induced liver injury in BALB/C mice:Suggestde roles for tregs,estrogen,and IL-6[J]. PLo S One,2013,8:e61186.

[11] LEE WM. Drug-induced hepatotoxicity[J]. N Engl J Med,1995,333(17):1118-1127.

[12] ZHANG P,KE YM,FAN XC,et al. Clinical analysis of 324 cases of drug-induced liver injury[J]. World Chin J Dig,2013,21(33):3720-3723.(in Chinese)张平，柯玉满，樊小春，等．药物性肝损伤临床分析324例[J]．世界华人消化杂志，2013,21(33):3720-3723.

[13] CHALASANI N,BONKOVSKY HL,FONTANA R,et al. Features and outcomes of 899 patients with drug-induced liver injury:The DILIN prospective study[J]. Gastroenterology,2015,148(7):1340-1352.

[14] LUCENA MI. Phenotypic characterization of idiosyncratic drugin-duced liver injury:The influence of age and sex[J]. Hepatology,2009,49(6):2001-2009.

[15] REUBEN A,KOCH DG,LEE WM,et al. Drug-induced acute liver failure:Results of a U. S. multicenter,prospective study[J]. Hepatology,2010,52(6):2065-2076.

施引文献

资源附件(0)

访问统计