Drug and herbal/dietary supplements-induced liver injury:A tertiary care center experience

BACKGROUND Drug-induced liver injury(DILI) and herbal/dietary supplements(HDS) related liver injury present unique diagnostic challenges. Collaboration between the clinician and the pathologist is required for an accurate diagnosis and management.AIM To report our experience on the clinical-pathological findings of hepatic injury caused by drugs/HDS.METHODS A retrospective review of clinically proven cases of DILI/HDS who presented to our institution from January 1, 2013 to December 31, 2017 was performed. Slides were reviewed for histopathological patterns of injury and correlated with the causative agent. Out of 600 patients presenting with unexplained rise in liver enzymes undergoing biopsy, 107 were suspected to have DILI/HDS. Of these, 53 had a directly linked exposure to drug/herbal supplements. Fifteen patients were excluded for concurrent known liver disease. Thirty-eight patients with clinically proven DILI/HDS were finally included.RESULTS Thirty-eight cases of DILI/HDS with a male:female of 1:1.5 and mean age of 51 ±3 years were identified. DILI was identified in 84.2% cases while HDS injury in 15.8%. Acute hepatitis(42.1%) was the most common pattern of injury while granulomatous hepatitis(2.6%) was the least common. We found one case of acute-cholestasis due to rivaroxaban and two cases of cholestatic-hepatitis due to rizatriptan and trimethobenzamide-hydrochloride that, to the best of our knowledge, have not been previously reported. One case of steatohepatitis due to trimethoprim-sulfamethoxazole and three unusual cases of cholestatic-hepatitis with bile duct injury and steatosis due to dronedarone, C4-Extreme and hydroxycut, were also seen. Of our cohort, 81.6% of the patients fared well with discontinuation of drug and 18.4% underwent transplant; of which 42.9% were deceased.CONCLUSION We describe the clinical findings, histopathological patterns of injury and clinical outcomes caused by drugs. In particular, we report a few previously unreported/rarely observed clinical and histopathological patterns of hepatic injury.     

Drug-induced liver injury in hospitalized patients with notably elevated alanine aminotransferase

AIM:To identify the proportion,causes and the nature of drug-induced liver injury(DILI) in patients with notably elevated alanine aminotransferase(ALT).METHODS:All the inpatients with ALT levels above 10 times upper limit of normal range(ULN) were retrospectively identified from a computerized clinical laboratory database at our hospital covering a 12-mo period.Relevant clinical information was obtained from medical records.Alternative causes of ALT elevations were examined for each patient,including biliary abnormality,viral hepatitis,hemodynamic injury,malignancy,DILI or undetermined and other causes.All suspected DILI cases were causality assessed using the Council for International Organizations of Medical Sciences scale,and only the cases classified as highly probable,probable,or possible were diagnosed as DILI.Comments related to the diagnosis of DILI in the medical record and in the discharge letter for each case were also examined to evaluate DILI detection by the treating doctors.RESULTS:A total of 129 cases with ALT 10 ULN were identified.Hemodynamic injury(n = 46,35.7%),DILI(n = 25,19.4%) and malignancy(n = 21,16.3%) were the top three causes of liver injury.Peak ALT values were lower in DILI patients than in patients with hemodynamic injury(14.5 ± 5.6 ULN vs 32.5 ± 30.7 ULN,P = 0.001).Among DILI patients,one(4%) case was classified as definite,19(76%) cases were classified as probable and 5(20%) as possible according to the CIOMS scale.A hepatocellular pattern was observed in 23(92%) cases and mixed in 2(8%).The extent of severity of liver injury was mild in 21(84%) patients and moderate in 4(16%).Before discharge,10(40%) patients were recovered and the other 15(60%) were improved.The improved patients tended to have a higher peak ALT(808 ± 348 U/L vs 623 ± 118 U/L,P = 0.016) and shorter treatment duration before discharge(8 ± 6 d vs 28 ± 12 d,P = 0.008) compared with the recovered patients.Twenty-two drugs and 6 herbs were found associated with DILI.Antibacterials were the most common agents causing DILI in 8(32%) cases,followed by glucocorticoids in 6(24%) cases.Twenty-four(96%) cases received treatment of DILI with at least one adjunctive drug.Agents for treatment of DILI included anti-inflammatory drugs(e.g.,glycyrrhizinate),antioxidants(e.g.,glutathione,ademetionine 1,4-butanedisulfonate and tiopronin),polyene phosphatidyl choline and herbal extracts(e.g.,protoporphyrin disodium and silymarin).Diagnosis of DILI was not mentioned in the discharge letter in 60% of the cases.Relative to prevalent cases and cases from wards of internal medicine,incident cases and cases from surgical wards had a higher risk of missed diagnosis in discharge letter [odds ratio(OR) 32.7,95%CI(2.8-374.1),CONCLUSION:DILI is mostly caused by use of antibacterials and glucocorticoids,and constitutes about one fifth of hospitalized patients with ALT 10 ULN.DILI is underdiagnosed frequently.     

Clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan

BACKGROUND Coronavirus disease 2019(COVID-19) has become a worldwide pandemic. We investigated the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan by retrospectively analyzing the epidemiological, clinical, and laboratory data for 218 COVID-19 patients and identifying the risk factors for liver injury by multivariate analysis.AIM To investigate the clinical characteristics and risk factors for liver injury in COVID-19 patients in Wuhan.METHODS The 218 patients included 94 males(43.1%), aged 22 to 94(50.1 ± 18.4) years. Elevated aspartate aminotransferase(AST) and alanine aminotransferase(ALT) were present in 42(53.2%) and 36(45.6%) cases, respectively, and 79(36.2%) patients had abnormally elevated transaminase levels at admission. Patients with liver injury were older than those with normal liver function by a median of 12 years, with a significantly higher frequency of males(68.4% vs 28.8%, P 0.001) and more coexisting illnesses(48.1% vs 27.3%, P = 0.002). Significantly more patients had fever and shortness of breath(87.3% vs 69.8% and 29.1% vs 14.4%, respectively) in the liver injury group. Only 12(15.2%) patients had elevated total bilirubin. ALT and AST levels were mildly elevated [1-3 × upper limit of normal(ULN)] in 86.1% and 92.9% of cases, respectively. Only two(2.5%) patients had an ALT or AST level 5 × ULN. Elevated γ-glutamyl transpeptidase was present in 45(57.0%) patients, and 86.7% of these had a γ-glutamyl-transpeptidase level 135 U/L(3 × ULN). Serum alkaline phosphatase levels were almost normal in all patients. Patients with severe liver injury had a significantly higher frequency of abnormal transaminases than non-severe patients, but only one case had very high levels of aminotransferases.RESULTS Multivariate analysis revealed that male sex, high D-dimer level, and high neutrophil percentage were linked to a higher risk of liver injury. The early stage of COVID-19 may be associated with mildly elevated aminotransferase levels in patients in Wuhan. Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.CONCLUSION Male sex and high D-dimer level and neutrophil percentage may be important predictors of liver injury in patients with COVID-19.     

Effect of donor age on graft function and longterm survival of recipients undergoing living donor liver transplantation

BACKGROUND: Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation(LDLT) has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient survival.METHODS: All LDLT cases(n=159) were divided into the older(donor age ≥50 years, n=10) and younger(donor age 50 years,n=149) donor groups. Donor graft and recipient condition pre-,intra- and post-operation were compared between the two groups.In particular, graft functions and recipient survivals were analyzed.RESULTS: The median donor age was 58.5(52.5-60.0) years in the older donor group and 25.0(23.0-32.0) in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups(P0.05). However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group(1900 vs 1200 m L, P=0.023). The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively(P=0.459).The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively(P=0.811).CONCLUSION: It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients' survival.     

Effect of Chinese drugs combined electroacupuncture on seminal quality in oligospermia and asthenospermia patients

正Objective To observe the effect of Chinese drugs combined electroacupuncture (EA) on seminal quality of oligospermia and asthenospermia patients.Methods Totally 124 oligospermia and asthenospermia patients were assigned to three groups according to random digit table,the EA group (A, 41 cases), the Chinese drugs group(B, 41 cases), and the EA plus Chinese drugs group(C, 42 cases). Patients in group B took Shengjing Powder. Those in group A received transcutaneous electrical acupoint stimulation (TEAS) with HANS. Those in group C took Shengjing Powder and received TEAS with     

Abnormal liver chemistries as a predictor of COVID-19 severity and clinical outcomes in hospitalized patients

BACKGROUND Abnormal liver chemistries are common findings in patients with Coronavirus Disease 2019(COVID-19).However,the association of these abnormalities with the severity of COVID-19 and clinical outcomes is poorly understood AIM We aimed to assess the prevalence of elevated liver chemistries in hospitalized patients with COVID-19 and compare the serum liver chemistries to predict the severity and in-hospital mortality.METHODS This retrospective,observational study included 3380 patients with COVID-19 who were hospitalized in the Johns Hopkins Health System(Baltimore,MD,United States).Demographic data,clinical characteristics,laboratory findings,treatment measures,and outcome data were collected.Cox regression modeling was used to explore variables associated with abnormal liver chemistries on admission with disease severity and prognosis RESULTS A total of 2698(70.4%)had abnormal alanine aminotransferase(ALT)at the time of admission.Other more prevalent abnormal liver chemistries were aspartate aminotransferase(AST)(44.4%),alkaline phosphatase(ALP)(16.1%),and total bilirubin(T-Bil)(5.9%).Factors associated with liver injury were older age,Asian ethnicity,other race,being overweight,and obesity.Higher ALT,AST,T-Bil,and ALP levels were more commonly associated with disease severity.Multivariable adjusted Cox regression analysis revealed that abnormal AST and T-Bil were associated with the highest mortality risk than other liver injury indicators during hospitalization.Abnormal AST,T-Bil,and ALP were associated with a need for vasopressor drugs,whereas higher levels of AST,T-Bil,and a decreased albumin levels were associated with mechanical ventilation CONCLUSION Abnormal liver chemistries are common at the time of hospital admission in COVID-19 patients and can be closely related to the patient’s severity and prognosis.Elevated liver chemistries,specifically ALT,AST,ALP,and T-Bil levels,can be used to stratify risk and predict the need for advanced therapies in these patients.     

Risk factors for alcohol-related liver injury in the island population of China: a population-based case-control study

AIM：To investigate the association of alcohol dose, duration of drinking and obesity with abnormal alcohol-related liver injury indicators, the prevalence of alcohol-related liver injury in the island population of China.METHODS：Randomized multistage stratified cluster sampling from the island population of China was used in the population-based case-control study. Then interview, physical examination, laboratory assessments and ultrasonography were done. RESULTS：Daily alcohol intake ≥ 20 g, duration of drinking ≥ 5 years and obesity were closely related to alcohol-related liver injury （P 〈 0.05）. The odds-ratio （OR） （95% CI） was 1.965 （1.122-3.442）, 3.412 （1.789-6.507） and 1.887 （1.261-2.824）, respectively. The prevalence rate of alcohol-related liver injury in ≥ 20 g daily alcohol intake group and 〈 20 g daily alcohol intake group was 37.14% and 12.06%, respectively. The prevalence rate of alcohol-related liver injury in ≥ 5 years drinking group and 〈 5 years drinking group was 34.44% and 8.53%, respectively. No significant dose-response relation was found between daily alcohol intake and abnormal alcohol-related liver injury indicators as well as between duration of drinking and abnormal alcohol-related liver injury indicators. There was no significant difference in the prevalence of alcohol-related liver injury between beer drinking group and yellow rice wine drinking group, hard liquor drinking group, multiple drinking group.CONCLUSION：The risk threshold of daily alcohol intake is 20 g and duration of drinking inducing alcohol-related liver injury 5 years in the island population of China. Liver injury induced by obesity should be concerned.     

Effects of extract from Ginkgo biloba on carbon tetrachloride-induced liver injury in rats

AIM: To study the effects of extract from Ginkgo biloba (EGb) containing 22% flavonoid and 5% terpenoid on chronic liver injury and liver fibrosis of rats induced by carbon tetrachloride (CCl4). METHODS: All rats were randomly divided into control group, CCl4-treated group, colchicine-treated group and EGb-protected group. Chronic liver injury was induced in experimental groups by subcutaneous injection of CCl4 and fed with chows premixed with 79.5% corn powder, 20% lard and 0.5% cholesterol (v/v). EGb-protected group was treated with EGb (0.5 g/kg body weight per day) for 7 wk. At the end of wk 8, all the rats were killed. Liver function, liver fibrosis, oxidative stress and expression of transforming growth factorβ1 (TGF-β1), a-smooth muscle actin (α-SMA) and typeⅠcollagens in liver were determined. In addition, pathology changes of liver tissue were observed under light microscope. RESULTS: The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (Alb) in EGb-protected group were notably improved as compared with the CCL4-treated group (P < 0.01). The contents of serum hyaluronic acid (HA), typeⅢprocollagen (PCⅢ), typeⅣcollagen (CIV) and the expression of hepatic tissue TGF-β1,α-SMA and typeⅠcollagen in EGb-protected group were significantly lower than those in CCL4-treated groups (P < 0.05, P < 0.01). The degrees of liver fibrosis in EGb-protected groups were lower than those in CCL4-treated groups (6.58±1.25 vs 9.52±2.06, P < 0.05). Compared to the CCL4-treated group, the levels of plasma glutathoine peroxidase (Se-GSH-Px), superoxide dismutase (SOD) and malondialdehyde (MDA) were strikingly improved also in EGb-protected group (P < 0.05, P < 0.01). CONCLUSION: EGb resists oxidative stress and thereby reduces chronic liver injury and liver fibrosis in rats with liver injury induced by CCl4     

Drug-induced liver injury in inflammatory bowel disease: 1-year prospective observational study

AIM To analyze 1-year liver injury burden in inflammatory bowel disease(IBD) patients. METHODS During a 6-mo inclusion period, consecutive IBD cases having a control visit at IBD center were included. Basic demographics, IBD phenotype and IBD treatment were recorded on entry. Aminotransferase(AT) activities of ALT, AST, ALP and gamma-glutamyl transpeptidase(GGT) were measured at baseline, 3 mo prior to study entry and prospectively every 3 mo for 1 year. Liver injury patterns were predefined as: Grade 1 in ALT 1-3 × upper limit of normal(ULN), grade 2 in ALT 3 × ULN, hepatocellular injury in ALT 2 × ULN, cholestatic injury in simultaneous GGT and ALP elevation ULN.Persisting injury was reported when AT elevations were found on 1 measurement. Risk factors for the patterns of liver injury were identified among demographic parameters, disease phenotype and IBD treatment in univariate and multivariate analysis. Finally, implications for the change in IBD management were evaluated in cases with persisting hepatocellular or cholestatic injury.RESULTS Two hundred and fifty-one patients were included having 917 ALT and 895 ALP and GGT measurements. Over one year, grade 1 injury was found in 66(26.3%), grade 2 in 5(2%) and hepatocellular injury in 16 patients(6.4%). Persisting hepatocellular injury was found in 4 cases. Cholestasis appeared in 11 cases(4.4%) and persisted throughout the entire study period in 1 case. In multivariate analysis, hepatocellular injury was associated with BMI(OR = 1.13, 1.02-1.26), liver steatosis(OR = 10.61, 2.22-50.7), IBD duration(1.07, 1.00-1.15) and solo infliximab(OR = 4.57, 1.33-15.7). Cholestatic liver injury was associated with prior intestinal resection(OR = 32.7, 3.18-335), higher CRP(OR = 1.04, 1.00-1.08) and solo azathioprine(OR = 10.27, 1.46-72.3). In one case with transient hepatocellular injury azathioprine dose was decreased. In 4 cases with persisting hepatocellular injury, fatty liver or alcohol were most likely causes and IBD treatment was pursued without change. In the case with persisting cholestatic injury, no signs of portal hypertension were identified and treatment with infliximab continued.CONCLUSION Liver injury was frequent, mostly transient and rarely changed management. Infliximab or azathioprine were confirmed as its risk factors indicating the need for regular AT monitoring.     

药物性肝病临床特征及预后分析

目的 探讨药物性肝病(DILD)的病因及临床特点以提高临床医师对该病的认识.方法 对2000-2006年在浙江大学医学院附属第一医院住院的332例DILD进行回顾性研究,分析其所用药物、临床表现、临床分型和转归及预后相关因素.结果 引起DILD的药物中,中药占首位(27.1%),其次为抗结核药(13.3%),再次为免疫抑制剂(10.8%).肝病临床类型以肝细胞多见(43.1%),混合型次之(32.5%),胆汁淤积型相埘较少(24.4%).经住院积极治疗后,显效达50.8%,有效达26.6%,未愈占7.5%.经多因素logistic回归分析表明预后与血清白蛋白(Alb)、总胆汁酸(TBA)、直接胆红素(DBil)及PT有关,Alb值越低,预后差的概率越高,而TBA、DBil、PT则相反,值越高预后差的概率越高.结论 引起DILD的药物种类繁多,临床类型以肝细胞型多见,混合型次之,胆汁淤积型相对较少.预后与Alb、TBA、DBil、PT水平相关.     

急性药物性肝损伤179例临床分析

目的探讨急性药物性肝损伤临床表现特点、分型、病因、治疗及分析预后，以指导临床诊断和治疗。方法采用急性药物性肝损伤诊断及分类国际共识标准，回顾性调查近5年来中山大学附属第一医院179例急性药物性肝损伤住院患者的临床资料。结果本研究中有48％的患者无明显临床症状体征，其余亦缺乏特异性；有肝细胞型137例（76．11％），胆汁淤积型24例（14．33％），混合型18例（10．56％）。符合重症肝损伤者6例；引起肝功能损伤的药物种类很多，本组最常见的为化疗药、抗结核药、中草药；85．55％患者预后较好，主要肝功能指标于30d内恢复至正常上限两倍以内。6例发展为重型肝损伤，预后较差。结论急性药物性肝损伤症状缺乏特异性，不能单纯根据症状确定诊断；本组患者急性药物性肝损伤的类型以肝细胞型为主；临床上可以引起急性药物性肝损伤的药物种类很多，但以化疗药、抗结核药、中草药发生率最高，临床应用此类药物时，应注意监测肝功能在本组患者中急性药物性肝损伤一般预后较好，但亦可发生严重肝损害，应及时采取措施处理。     

中药与西药所致急性药物性肝损伤临床特点对比分析

目的探讨中药和西药所致急性药物性肝损伤的临床特点、分型和肝功能变化特点,以提高临床医师对该病的认识。方法采用急性药物性肝损伤诊断及分类标准,回顾性分析近10年来我院168例因急性药物性肝损伤住院患者的临床资料。结果168例急性药物性肝损伤患者中,联合应用中西药所致7例,中药所致者81例（占50．3％）,西药所致者80例（占49．7％）。中药组女性62例（占76．5％）,西药组43例（占53．8％）,两组比较差异有显著性（P〈0．01）;两组的年龄构成比较无显著性差异。在161例患者中23例无明显临床表现,其中西药组有19例,明显高于中药组,两组比较差异有显著性（P〈0．01）;中药组肝细胞型、胆汁淤积型和混合型肝损伤分别有71例（87．7％）、0例和10例（12．3％）,西药组分别为54例（67．5％）、2例（2．5％）和24例（30％）,中药组肝细胞型所占比例高于西药组（P〈0．01）,西药组混合型比例高于中药组（P〈0．01）;治疗前两组各项肝功能指标比较无显著性差异;西药组7天内发病者明显多于中药组（P〈0．01）。结论中药所致的急性药物性肝损伤在性别、临床表现、分型和发病时间上有所不同。     

30例老年药物性肝病的临床分析

目的对老年药物性肝病特点进行分析,提高对该病的认识。方法对2006年1月～2009年6月,复旦大学附属中山医院住院治疗的30例≥60岁的老年药物性肝病患者的病例资料进行回顾性分析,并与58例同期住院的60岁以下成年人药物性肝病临床特点进行比较。结果老年药物性肝病潜伏期为10d～1年。引起老年药物性肝病的药物主要包括：中药（43.3％）、非甾体类消炎药（10．0％）、HMG—CoA还原酶抑制剂（10．0％）。主要症状包括：纳差（60．0％）、黄疸（56．7％）、乏力（53．3％）。临床分型为：肝脏检查异常3．3％;肝损伤96．7％,其中包括肝细胞损伤型33．3％、胆汁淤积型40．0％、混合型23．3％。老年组潜伏期≤4周的比例低于60岁以下中青年组;老年组由抗微生物药物引起药物性肝病的比例低于60岁以下中青年组,老年组纳差的发生率高于60岁以下中青年组。结论临床医师应提高对老年人药物性肝病的认识,重视中草药所致的药物性肝病。     

药物性肝病的诊断与治疗进展

药物性肝病(DILD)是指在使用某种或几种药物后,由药物或其代谢产物引起的肝脏损害。随着新药不断研发和应用于临床,药物性肝病的发病率也在逐年增高,引起人们对药物性肝损伤的重视及研究。此文主要就药物性肝病的诊断与治疗进展作一综述。     

回顾性分析临床药物性肝病109例

目的:分析总结近年来药物性肝病的情况,提高本病的诊断治疗水平.方法:回顾调查1999-2004年各种药物致药物性肝病109例,分析统计每年药物性肝病发病例数的变迁及临床情况.结果:抗生素、非甾体抗炎药、治疗甲亢药、中草药、抗结核药是主要的损肝药物.急性药物性肝损伤是逐年增加的,肝损伤发生时间因所用药物不同而差异很大,无临床症状者占22.94%,有症状者占77.06%.慢性药物性肝病7例,急性药物性肝损伤102例(肝细胞损伤型67例,胆汁淤积型23例,混合型12例);治愈17例,好转81例,未愈10例,死亡1例.结论:药物性肝病多数表现为急性药物性肝损伤,少数为慢性肝损伤,取决于药物的种类、剂量和给药途径.药物性肝病的早期诊断与重视程度和认识有关,加强规范合理用药及用药监测可以预防本病.     

2006年-2011年国内老年药物性肝损伤的临床特点

目的总结5年来国内老年药物性肝损伤病例分析文献报道的总体临床特点。方法以"老年"和"药物性肝损伤"为关键词,检索2006年-2011年万方学术论文数据库,记录文献中患者性别、年龄、用药种类、临床表现、临床分型和预后的相关数据进行总结分析。结果 7篇文献记录了465例患者性别,其中男312例(67.10%),女153例(32.90%)。平均年龄76岁。收集5篇文献记录了328例用药信息,导致肝损伤的药物主要为抗微生物类药70例(21.34%)、心血管类药64例(19.51%)、中药47例(14.33%)、解热镇痛类药45例(13.72%)。7篇文献记录了443例临床表现,较常见的临床症状为:乏力(65.32%)、纳差(64.96%)、腹胀(48.5%)、黄疸(46.75%)等。5篇文献记录240例临床分型,其中肝细胞型136例,胆汁淤积型55例,混合型49例。5篇文献记录了176例预后,其中治愈117例(66.48%),好转例52(29.54%),无效或恶化5例(2.84%),死亡2例(1.14%)。结论国内文献报道老年药物性肝损伤男性多于女性,导致肝损伤药物主要为抗微生物类药、心血管类药、中药、解热镇痛药和抗肿瘤药,临床分型以肝细胞型最为常见,患者大多预后良好。     

62例老年非病毒性肝损伤患者临床特点和病因分析

目的探讨老年非病毒性肝损伤患者的临床特点和病因,指导临床诊断和治疗。方法回顾性分析62例2006年1月至2009年6月期间复旦大学附属中山医院收治的非病毒（已知甲～戊型肝炎病毒、单纯疱疹病毒、巨细胞病毒、EB病毒和柯萨奇病毒）感染所致的60岁及以上肝功能异常患者的临床资料,并与98例同期住院的60岁以下成年人非病毒性肝损伤患者进行比较。结果老年jE病毒性肝损伤患者临床表现无特异性,乏力和纳差的发生率明显高于非老年组（P〈0．05）;老年组患者中引起肝功能异常的病因以药物性肝病（DILD）居首位（40．32％）,其它依次为非酒精性脂肪性肝病（NAFLD）（20．97％）、胆源性疾病（17．74％）、心肺功能不全（9．68％）;丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）在DILD患者中增高最为明显,老年组DILD患者ALT和AST高于非老年组[ALT：（775．83±478．51）vs（526．44±401．54）U／L,AST：（663．61±464．85）VS（457．45±521．78）U／L;P〈0．01]。引起老年人肝损伤的药物主要是中药（40％）、非甾体类消炎药（12％）和HMG-CoA还原酶抑制剂（12％）。结论老年非病毒性肝损伤患者以DILD最为多见,其次为NAFLD和非肝源性疾病导致肝损伤,临床医师应特别重视老年人药物性肝病的防治。     

药物性肝损害88例临床分析

目的探讨药物性肝病的发病规律和防治方法。方法对本院药物性肝损害88例患者的临床资料进行回顾性分析。结果引起肝损害的药物种类繁多,以抗生素（包括抗结核药物）为最多,占47.7%,其次为中药,占25%;临床以肝细胞型多见,占61.4%,胆汁淤积型占20.1%,混合型占18.2%;主要临床表现有乏力、纳差、黄疸、恶心、呕吐等;肝功能受损以ALT、GGT和AKP增高为主。临床治愈67例,好转16例,自动出院3例,死亡1例。结论引起药物性肝损害的药物种类很多,过去认为比较安全的中药也可引起肝损害,值得重视。     

老年人药物性肝损害88例临床分析

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(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。