老年人急性药物性肝损伤临床特点分析

Clinical analysis of drug-induced liver injury in the elderly

目的探讨老年人急性药物性肝损伤的病因、分型和肝功能变化特点。方法采用急性药物性肝损伤诊断标准及国际共识分型标准，回顾性分析近10年来我院167例因急性药物性肝损伤住院患者的临床资料。结果急性药物性肝损伤患者167例，老年组和中青年组分别为53例（31．7％）和114例（68．3％）；导致急性药物性肝损伤最常见的药物为中药类（47．9％），老年组心血管系统用药比例高于中青年组（P〈0．05），临床表现以乏力（50．3％）和黄疸（46．7％）者多见，无明显『临床表现者仅25例（15．0％），老年组与中青年组临床表现差异无统计学意义；老年组肝细胞型、胆汁淤积型和混合型肝损伤分别为40例（75．5％）、5例（9．4％）和8例（15．1％），中青年组分别为91例（78．9％）、8例（7．4％）和15例（13．7％），两组比较差异无统计学意义（x^2=0．80，P〉0．05）。结论老年患者药物性肝损伤以中草药类及心血管药物为主，临床表现缺乏特异性。

Objective To investigate the causes, clinical features, classifications and liver function change of drug-induced liver damage （DILD） in the elderly. Methods One hundred and sixty seven inpatients with acute drug-induced liver injury in our hospital in the past ten years （January 2000 to December 2009） were retrospectively investigated, and the diagnosis and classification methods of acute DILD were based on international consensus meeting （international criteria）. Results Among 167 DII.I cases, there were 53 cases （31.7%） in the older group and 114 cases （68.3%） in middle-youth age group. Fatigue and jaundice were the more common symptoms, accounting for 50.3%and 46.7%, respectively. In 167 cases, no obvious symptoms and signs were shown in 25 cases. There were no significance differences in clinical manifestation between two groups. Many drugs could induce liver injury. The most common drugs inducing DILD were Chinese traditional and herbal drugs, accounting for 47.9%. Drugs used in heart diseases and inducing liver iniury were more commonin the older group. In this study, 40 （75.5%）, 5 （9.4%） and 8 （15.1%） cases were designated as hepatocellular, cholestetic and mixed DILD in the older group, and 91 （78.9%）, 8 （7.4%） and 15 （13.7%） in middle youth age group, respectively. There were no significance differences between two groups in classifications. Conclusions Many drugs could cause liver injury. The symptoms of acute DILD are nonspecific. Drugs used in heart diseases and inducing liver injury are more common in older patients.