老年药物性肝损伤患者临床特征分析

Clinical feature of elderly patients with drug-induced liver injury:An analysis of 44 cases

目的分析老年药物性肝损伤(DILI)患者的临床特征,以为临床干预提供依据。方法2018年12月~2024年2月我院老年医学科诊治的老年多种疾病患者181例,常规行临床分型和疾病程度分度。应用单因素和多因素Logistic回归分析影响DILI病情严重程度的危险因素。结果在181例老年患者中,发现DILI者44例(24.3%),其中肝细胞损伤型28例,胆汁淤积型12例,混合型4例;轻度25例,中度10例,重度8例,死亡1例;可疑药物为中草药占27.3%,保健类药物占22.7%,内分泌系统疾病用药占13.6%,心脑血管疾病用药占11.4%,等;DILI组年龄为72(66,76)岁,显著大于非DILI组【67(65,69),P<0.05】,多种疾病、饮酒、脂肪肝和高脂血症占比分别为79.6%、27.3%、56.8%和84.1%,显著高于非DILI组(分别为11.7%、3.6%、12.4%和8.7%,均P<0.05);9例≥3级肝损伤患者年龄为73(67,75)岁,显著大于35例≤2级肝损伤者【67(66,70)岁,P<0.05】,饮酒、多种疾病和合并脂肪肝占比分别为88.9%、100.0%和88.9%,均显著大于≤2级肝损伤者(分别为11.4%,74.3%和48.6%,均P<0.05),多因素Logistic回归分析表明,高龄【OR:1.67,95%CI:1.26~3.05】、饮酒【OR:2.43,95%CI:1.35~3.17】和脂肪肝【OR:2.14,95%CI:1.50~4.75】均是影响老年DILI患者病情严重程度的独立危险因素(P<0.05)。结论中草药、保健类药物、内分泌和心脑血管系统疾病用药容易导致老年基础疾病多的患者发生DILI,戒酒、降低脂肪肝程度和控制好疾病发作可能减轻DILI严重程度,值得临床深入研究。

Objective This study was conducted to summarize clinical feature of elderly patients with drug-induced liver injury(DILI),and to investigate risk factors impacting severity of liver illness.Methods 181 elderly patients with various underlying diseases were encountered in our hospital between December 2018 and February 2024,and DILI was routinely diagnosed,catalogued and liver injury determined.Univariate and multivariate Logistic regression analysis was applied to find risk factors for liver injuries.Results Of 181 elderly patients,DILI was diagnosed in 44 cases(24.3%),including hepatocellular injury in 28 cases,cholestasis in 12 cases and mixed type in 4 cases;there were mild liver injury in 25 cases,moderate in 10 cases,severe in 8 cases and dead in 1 cases;suspected herbal medicines accounted for 27.3%,health care agents for 22.7%,agents for endocrine diseases for 13.6%and medicines for cardiovascular diseases for 11.4%,etc;ages in patients with DILI was 72(66,76)yr,much greater than[67(65,69)yr,P<0.05]in patients without DILI,percentages of multiple concurrent underlying diseases,alcohol abuse,fatty liver and hyperlipidemia were 79.6%,27.3%,56.8%and 84.1%,all much higher than 11.7%,3.6%,12.4%and 8.7%(all P<0.05)in patients without DILI;ages in 9 patients with liver injury grade 3 or more was 73(67,75)yr,much older than[67(66,70)yr,P<0.05]in 35 patients with liver injury of grade 2 or less,percentages of ethanol intake,multiple underlying diseases and concurrent fatty liver was 88.9%,100.0%and 88.9%,all significantly greater than 11.4%,74.3%and 48.6%(all P<0.05)in patients with grade 2 or less liver injuries;multivariate Logistic regression analysis showed that elderly[OR:1.67,95%CI:1.26-3.05],alcohol abuse[OR:2.43,95%CI:1.35-3.17]and fatty liver[OR:2.14,95%CI:1.50-4.75]were all the risk factors impacting severity of liver injuries in elderly patients with DILI(P<0.05).Conclusion Herbal medicine,health care drugs,agents for endocrine and cardiovascular diseases could lead to DILI occurrence in elderly patients with multiple system diseases,in which drug-drug interactions might involve in this setting,and clinicians should carefully deal with underlying diseases,and prescribe medicines as necessary as possible.