86例老年人药物性肝损害的病因和临床特点

The etiology and clinical features of 86 cases of drug-induced liver injury in old people

目的探讨老年人药物性肝损害的病因和临床特点，以提高对该病的认识。方法对2004—2010年间我所住院的86例药物性肝损害的资料进行回顾性分析，并按Marin药物性肝损害评分系统进行评价。结果引起药物性肝损害的药物类型居前四位的依次为抗微生物药物19例、抗肿瘤药17例、中草药16例与心血管用药14例，分别占22％、19．8％、18．6％与16．3％，其后为神经科用药和解热止痛药分别为4％，再次为降糖药、抗甲亢药、免疫抑制剂各占2．3％，雄性激素1．2％。8例不详占5．8％。临床分型：肝细胞型49例占57％，胆汁淤积型25例29％，混合型12例占14％。结论抗微生物药、抗肿瘤药、中草药和心血管用药是引起老年人药性肝损害的较常见的药物，使用此类药物时宜小心谨慎，密切监测肝功能的变化。

Objeetive To enhance the understanding of drug-induced liver injury by investigating the causes and clinical features of drug-induced liver injury cases in old people. Methods Eight- six drug-induced liver injury cases in old people admitted to our hospital from 2004-2010 were retrospectively analyzed and evaluated by using Maria＇s diagnostic scale. Results The four predominant etiologi cal drugs were antibiotics （ 19 cases, 22% ）, antitumor drugs （ 17 cases, 19.8% ）, traditional Chinese herbs （ 16 cases, 18.6% ） and cardiovascular drugs （ 14 cases, 16.3% ）, followed by neurologists medicines （ 4% ） and antipyretic analgesics （ 4% ）. Other drugs included glucose-lowing drugs, hyper- thyroidism drugs and immunosuppressive agents, each of them accounted for 2.3% of the all cases. 1.2% cases attributed to male hormone drugs and the causative drugs could not be clarified in 8 cases （ 5.8% ）. For clinical classification, 49 cases （ 57% ） were hepatocellular type, 25 cases （ 29% ） were cholestasis type, and 12 cases （ 14% ） were mixed type. Conclusions Antibiotics, antitumor drugs, traditional Chinese herbs and cardiovascular drugs are the common drugs cause drug-induced liver injury among old people, doctors should be discreet and closely monitor the liver function when using these drugs.