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。

Analysis of 30 cases of drug-induced liver disease in the elderly

Objective To analyze the features of drug-induced liver disease （DILD） in the elderly and improve the knowledge of it. Methods 30 elderly patients diagnosed as DILD which admitted to our hospital from Jan 2006 to Jun 2009 were reviewed retrospectively, and were compared with adult patients younger than 60 years old. Results The latent period of DILD in the elderly was from ten days to one year. The main agents causing DILD in the elderly included herbal medicine （43.3%）, nonsteroidal anti-inflammatory drugs （10.0%）, HMG-CoA reductase inhibitors （10.0%）. Main symptoms involved nausea （60.0%）, jaundice （56.7%）, fatigue （53.3%）. 3.3% were classified as abnormality of liver tests and 96.7% as liver injury, including： hepatocellular type 33.3%, cholestatic type 40.0%, and mixed type 23.3%. The patients with the latent period less than 4 weeks in the elderly group were less than that of younger group, fewer patients were induced by anti-inflammatory drugs in the elderly group than in the younger group, and the frequency of nausea occurred in the elderly group was higher than that of the other. Conclusions Clinicians should raise the understanding of the DILD in the elderly, especially the awareness of DILD induced by Chinese herbal medicine.