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

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

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(93.9%),无效及死亡30例(3.2%);65~69岁组治愈16例(2.8%),好转528例(92.0%),无效及死亡30例(5.2%);70~74岁组治愈9例(2.8%),好转305例(94.1%),无效及死亡10例(3.6%),结果显示不同年龄段DILI患者病死率差异无统计学意义(P>0.05)。老年DILI患者数占住院DILI患者数的比例,从2009年的15.90%上升至2013年的22.05%,2019年上升至27.51%,11年间上升约1.73倍。患者的地区分布以华北地区最多(47.08%),其中以河北省最多,占24.92%,山西省占10.96%,内蒙古占10.25%;其次为东北地区,占17.85%;另外,北京市占11.53%。结论老年DILI患者数占住院DILI患者数的比例总体呈上升趋势,临床分型以胆汁淤积型为主,且多数进展为慢性DILI及药物性肝硬化,需重视老年DILI的早期诊断、早期干预及规范治疗。

Objective To investigate the features and changing trend of drug-induced liver injury(DILI)in the elderly from 2009 to 2019,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.