老年人急性药物性肝损伤的调查分析

目的回顾性调查我院老年急性药物性肝损伤病例并进行关联性评价。方法收集58例急性药物性肝损伤住院病例的肝损伤病史和住院诊治经过。采用急性药物性肝损伤国际共识意见的量化评分系统，评价药物与肝损伤的相关程度并列出可能导致急性药物性肝损伤的主要药物。结果58例中急性药物性肝损伤与药物之间的关联性程度及其比例依次为：极有可能（评分〉8分）占14．6％，很可能有关（6—8分）占38．9％，可能有关（3—5分）占36．6％，可能无关（1～2分）占9．9％，无关（≤0分）占0。男女比例接近，平均年龄（63．0±7．5）岁，重症药物性肝损伤2例（3．45％），死亡1例，病死率1．7％。导致急性肝损伤的药物种类繁多，其中以中成药或中草药（36．2％）和抗结核药物（17．2％）多见。结论我院急性药物性肝损伤住院诊断病例数有逐年增加趋势，国际共识意见的量化评分系统有助于重新审定急性肝损伤与药物之间的关联程度，抗结核药物和中成药或中草药可能是急性药物性肝损伤的主要病因。

Analysis on Drug-Induced Acute Liver Injury in Older Patients

Objective To evaluate the causality by investigating the older inpatients with drug induced acute liver injury（ DIL- I ） retrospectively. Methods Fifty-eight senile cases with DILI were collected, and the medical history of liver injury and process of diagnosis and treatment were analyzed. The international consensus criteria was applied to assess the probability of a causal correlation between drug exposure and liver injury, and the drugs suspected to induce liver injury were listed. Results Among 58 patients, the possibility of the causality between suspected drug and liver injury were as follows： highly probably relevant（ 〉 8, 14.6% ）, probably relevant （ 6-8,38.9% ）, possibly relevant （ 3-5,36.6% ）, possibly irrelevant （ 1-2,9.9% ）, irrelevant （ ≤0,0 ）. The sex ratio was no difference and average age was （63.0 ± 7.5 ） years old. Two cases （3.45 % ） were diagnosed as severe DIL- I,and the mortality rate was 1.7% （ 1/58 ）. The drugs most commonly causing DILI were antitubereulosis drugs（ 17.2% ） and Chinese traditional medicine（ 36.2% ）. Conclusions The number of patients with DILl was increasing in last few years. The international consensus criteria were helpful to assess the causality between drug and acute liver injury. Antituberculosis drugs and herbal medicine may be the main causes of DILI in China.