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.
[1]LU RJ, ZHANG Y, TANG FL, et al.Clinical characteristics of drug-induced liver injury and related risk factors[J].Exp Ther Med, 2016, 12 (4) :2606-2616.
|
[2]LEE BM, LEE WC, JANG JY, et al.Clinical features of drug-induced liver injury according to etiology[J].J Korean Med Sci, 2015, 30 (12) :1815-1820.
|
[3]ZHANG Y, ZHANG GS, BAO ZJ, et al.Controlled clinical studies on drug-induced liver injury in the elderly Chinese patients:a literature review[J].Clin J Gen Pract, 2013, 12 (11) :890-893. (in Chinese) 张颖, 张赣生, 保志军, 等.国内老年人药物性肝损伤的临床对照研究文献分析[J].中华全科医师杂志, 2013, 12 (11) :890-893.
|
[4]MITCHELL SJ, HILMER SN.Drug-induced liver injury in older adults[J].Ther Adv Drug Saf, 2010, 1 (2) :65-77.
|
[5]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology.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.
|
[6]STINE JG, SATEESH P, LEWIS JH.Drug-induced liver injury in the elderly[J].Curr Gastroenterol Rep, 2013, 15 (1) :299.
|
[7]LIN JY, ZHANG Y.Clinical features and pathogenesis of drug-induced liver injury in the elderly[J].Chin J Gerontol 2013, 33 (16) :4098-4101. (in Chinese) 林佳瑶, 张玉.老年人药物性肝损伤的临床特点及发病机制[J].中国老年学杂志, 2013, 33 (16) :4098-4101.
|
[8]PANG LL, YANG WN, HOU FQ.Clinical manifestations of elderly and non-elderly patients with drug induced liver injury[J].AD-RJ, 2016, 18 (3) :163-169. (in Chinese) 逄丽丽, 杨婉娜, 侯凤琴.老年与非老年药物性肝损伤患者的临床特征[J].药物不良反应杂志, 2016, 18 (3) :163-169.
|
[9]DUAN XF, ZHANG YJ, QIAN F, et al.Analysis of etiology and clinical features of acute drug-induced liver injury in the elderly[J/CD].Chin J Clinicians:Electronic Edition, 2012, 6 (14) :3972-3975. (in Chinese) 段雪飞, 张亦瑾, 钱芳, 等.老年人急性药物性肝损伤的病因及临床特点分析[J].中华临床医师杂志:电子版, 2012, 6 (14) :3972-3975.
|
[10]RASCHI E, de PONTI F.Drug-and herb-induced liver injury:Progress, current challenges and emerging signals of post-marketing risk[J].World J Hepatol, 2015, 7 (13) :1761-1771.
|
[11]LIU LN, CHEN W, GUO HY, et al.Comparative study on clinical characteristics of 78 cases with drug-induced liver injury caused by Traditional Chinese Medicine or Western medicine[J/CD].Chin JLiver Dis:Electronic Edition, 2015, 7 (1) :46-50. (in Chinese) 刘丽娜, 陈婉, 郭海燕, 等.78例中药与西药引发药物性肝损伤的临床特性研究[J/CD].中国肝脏病杂志:电子版, 2015, 7 (1) :46-50.
|
[12]WANG YZ, ZHANG Y.Clinical features of drug-induced liver injury in the elderly:a review of Chinese literatures 2006-2011[J].Chin J Gastroenterol Hepatol, 2012, 21 (5) :473-476. (in Chinese) 王悦之, 张玉.2006年-2011年国内老年药物性肝损伤的临床特点[J].胃肠病学和肝病学杂志, 2012, 21 (5) :473-476.
|
[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.e7.
|
[14]TESCHKE R, DANAN G.Diagnosis and management of drug-induced liver injury (DILI) in patients with pre-existing liver disease[J].Drug Saf, 2016, 39 (8) :729-744.
|
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