86例老年药物性肝损害分析及预后影响因素的评估

目的 回顾性调查60岁及以上的药物性肝损害（drug-induced liver injure,DILI）患者,探讨其流行病学、病因、临床特点及预后影响因素.方法 对2000-2012年86例复旦大学附属华东医院住院老年DILI患者,回顾性分析其性别、引起肝损药物、伴随药物、临床表现、生化免疫、辅助检查,合并疾病和预后等,观察老年DILI的临床特点及规律.结果 DILI患者共86例,男性37例,女性49例,年龄60～89岁,平均（74.0±7.7）岁.引起老年DIH的药物以中草药为主（31.4％）,其次分别为抗生素（10.5％）、激素类（10.5％）、他汀类降脂药物（9.3％）,其他药物种类还包括化疗药、降糖药、神经精神类、NSAID等.各项生化免疫指标与预后分析发现AST、GGT较高者提示预后不良（195.5±219.9） umol/L vs （342.0±341.0） umol/L,P=0.020; （280.0±281.6） umol/L vs （288.4±257.4）umol/L,P=0.001].随着年龄的增加胆红素水平升高,且总胆红素、直接胆红素、间接胆红素均有不同程度升高（P=0.032,0.043,0.034）.结论 本资料中草药是引起老年DILI的最常见药物.老年DILI患者起病时AST、GGT较高者提示预后不良而随着年龄的增加胆红素水平升高.

Analysis on 86 cases of drug-induced liver injury in elderly and evaluation of prognostic factors

Objective To imply a retrospective analysis of DILl patients with the first diagnosis of DILI and aged more than 60 in Huadong Hospital, with the purpose to explore the etiology, clinical features, diagnostic criteria and prognostic factors. Methods A retrospective analysis of 86 DILI patients in hospital during 2000-2012 with first diagnosis of DILI was implemented, and data including the patients＇ gender, occupation, medication that caused liver damage, concomitant medication, clinical features, laboratory tests, concomitant diseases, allergies and prognosis was collected, thus clinical characteristics of DILI in elderly could be observed. Results This study included 86 patients, 37 male and 49 female. There were some types of medicine causing DILI ： Chinese herbal medicine mainly （ 31.4% ）, followed by antibiotics （ 10.5% ）, hormones （ 10.5% ）, lipid-lowering statin drugs （9.3%）, other drugs including chemotherapy drugs, hypoglycemic agents, neuropsychiatric class, NSAID, etc. AST and GGT could be good prediction of DILl in the elderly （195.5±219.9） umol/L vs （342.0±341.0） umol/L; （280.0±281.6） umol/L vs （288.4±257.4） umol/L] （P = 0.020 and 0.001 ）. The levels of bilirubin increased significantly with the growing age and TBIL, IBIL, DBIL all increased to various degrees. It was statistically different （P = 0.032, 0.043 and 0.034 respectively ）. Conclusion There was a wide variety of medicine causing liver damage and the largest proportion was Chinese herbal medicine. The first test of AST and GGT on admission could be used to predict the prognosis of the disease. Bilirubin＇s levels increased significantly with the growing age and TBIL, IBIL, DBIL all increased to various degrees.