老年人药物性肝损害88例临床分析

CLINICAL ANALYSIS ABOUT 88 ELDERLY PATIENTS OF DRUG INDUCED LIVER DISEASE

目的探讨致老年人药物性肝损害的药物种类、临床特点及防治原则。方法对1998年1月～2001年12月我院老年病科88例发生药物性肝损害的住院病例临床资料进行回顾性分析。结果药物性肝损害患病率为2.34%,老年患者联合用药多,引起肝损害以心血管药物最多(28.41%),其次是抗肿瘤药(23.86%),再次是抗生素(18.16%)。主要临床症状为疲乏纳差、恶心呕吐(36.36%),黄疸(9.09%),低热(5.7%),皮肤搔痒(4.5%),无症状者(61.4%)。临床治愈率75%,无一例出现肝衰竭。结论心血管药,抗肿瘤药和抗生素是引起老年人药物性肝损害的常见药物。老年患者肝功能受损后大多无明显症状。老年人肝损害与其肝药物代谢酶活性降低,长期联合用药有关。老年人应定期检测肝功能。

Objective To investigate the clinical features of drug induced liver disease (DILD) in the elderly, the types of causative agents and preventive methods. Methods The retrospectively study on the clinical data of 88 elderly patients of DILD was used. Results The incidence of DILD in the elderly in-patients is 2.34%. The elderly often took several kinds of medicine simultaneously. Among these causative agents, cardiovascular drugs were the most common ones (28.41%), followed by antineoplastics (23.86%), antibiotics ranged the third (18.16%). The principal clinical manifestations were as follows:fatigue, anorexia, nausea, vomiting (36.36%), jaundice(9.09%),low grade fever (5.7%) and skin itching (4.5%). 54 cases(61.4%) were asymptomatic. There were 66 cases which clinically cured (75%), no case of hepatic failure. Conclusions The common agents caused the elderly to develop hepatic injury were cardiovascular drugs, antineoplastics and antibiotics. Most of the patients were asymptomatic. The low activity of liver metabolic enzyme and using many drugs simultaneously were the important factors that related to the liver damage in the elderly. Liver functions of the elderly must be detected timely.