摘要
目的分析老年药物性肝损伤(DILI)患者的临床特征。方法回顾性分析2010年1月-2015年12月于大连市中心医院及大连医科大学附属第一医院住院的老年和中青年DILI患者的临床资料,包括性别、年龄、基础疾病、导致肝损伤药物的种类、主要临床表现、肝功能指标(血清ALT、AST、ALP、GGT、Alb、TBil、DBil)、临床分型、治疗及转归等。计数资料2组间比较采用χ~2检验,计量资料2组间比较采用Kolmogorov-Smirnov Z检验。结果 350例DILI患者中老年患者98例。老年组患者基础疾病前三位分别为心脑血管疾病(31.6%)、骨关节病(26.5%)、恶性肿瘤(18.4%),其所占比例均明显高于中青年组(5.6%、6.3%、4.8%),差异均有统计学意义(χ~2值分别为42.825、27.214、16.667,P值均<0.001),老年组患者感染性疾病所占比例明显低于中青年组(5.1%vs 29.4%,χ~2=23.768,P<0.001);引起肝损伤的药物中,老年组和中青年组应用最多的均为中药(53.1%、44.4%),老年组心血管系统用药及抗肿瘤药物所占比例(26.5%、9.2%)均明显高于中青年组(4.0%、3.2%)(χ~2值分别38.925、5.513,P值分别为<0.001、0.026);老年组黄疸(53.1%)及皮肤瘙痒者(22.4%)均明显高于中青年组(40.5%、7.1%)(χ~2值分别4.536、16.331,P值分别为0.041、<0.001);2组临床分型均以肝细胞损伤型为主,老年组肝细胞损伤型所占比例(60.2%)明显低于中青年组(81.7%),胆汁淤积型所占比例(28.6%)明显高于中青年组(7.9%),差异均有统计学意义(χ~2值分别17.807、25.389,P值均<0.001)。老年组患者ALT、ALP显著低于中青年组,而GGT、TBil、DBil明显高于中青年组(Z值分别为-3.141、-2.599、-7.449、-10.277、-9.278,P值均<0.01)。老年组患者住院过程中死亡3例,中青年组死亡1例。结论老年DILI患者的基础疾病和引起肝损伤的药物与中青年有所不同,胆汁淤积型所占的比例高于中青年,需要重视老年DILI的防治。
Objective To investigate the clinical features of elderly patients with drug-induced liver injury（DILI）.Methods A retrospective analysis was performed for the clinical data of elderly and young and middle-aged patients with DILI who were hospitalized in Dalian Municipal Central Hospital and The First Affiliated Hospital of Dalian Medical University from January 2010 to December 2015,including sex,age,underlying diseases,drugs causing liver injury,main clinical manifestations,liver function parameters [serum levels of alanine aminotransferase（ALT）,aspartate aminotransferase,alkaline phosphatase（ALP）,gamma-glutamyl transpeptidase（GGT）,albumin,total bilirubin（TBil）,and direct bilirubin（DBil） ],clinical type,treatment,and prognosis.The chi-square test was used for comparison of categorical data between groups,and the Kolmogorov-Smirnov Z test was used for comparison of continuous data between groups.Results Among the 350 patients with DILI,there were 98 elderly patients（elderly group）.The three most common underlying diseases in the elderly group were cerebrovascular and cardiovascular diseases（31.6%）,osteoarthropathy（26.5%）,and malignant tumor（18.4%）,and the elderly group had significantly higher proportions of patients with these diseases than the young and middle-aged group（31.6%/26.5%/18.4% vs 5.6%/6.3%/4.8%,χ~2=42.825,27.214,and 16.667,all P〈0.001）.Among the drugs causing liver injury,traditional Chinese medicine was applied most frequently in the elderly group and the young and middle-aged group（53.1% and44.4%,respectively）,and the elderly group had significantly higher proportions of patients using cardiovascular drugs or antitumor drugs than the young and middle-aged group（26.5%/9.2% vs 4.0%/3.2%,χ~2=38.925 and 5.513,P〈0.001 and P=0.026）.The elderly group had significantly higher proportions of patients with jaundice（53.1%） or pruritus（22.4%） than the young and middle-aged group（40.5%,7.1%）（χ~2=4.536 and 16.331,P=0.041 and P〈0.001）.T
作者
姬琛华
张竹青
王晓媛
卢书明
JI Chenhua ZHANG Zhuqing WANG Xiaoyuan et al(Department of Gastroenterology, Dalian Municipal Central Hospital, Dalian, Lia- oning 116033, China)
出处
《临床肝胆病杂志》
CAS
2017年第3期502-506,共5页
Journal of Clinical Hepatology
基金
辽宁省自然科学基金资助项目(2015020324)
大连市卫生局课题
关键词
药物性肝损伤
老年人
诊断
疾病特征
drug-induced liver injury
aged
diagnosis
disease attributes
