老年药物性肝损伤的临床特点

目的探讨引起老年药物性肝损伤的药物种类、临床特点及防治原则。方法对2005年1月～2009年6月复旦大学附属华东医院160例发生药物性肝损害的老年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3．17％（160／5047）；老年患者联合用药多，易出现肝损害，以心血管药物最多，构成比为25．6％（41／160），其次是抗肿瘤药，构成比为21．9％（35／160），再次是抗生素，构成比为18．1％（29／160）。主要临床症状为疲乏纳差、恶心呕吐，构成比为39．4％（63／160），黄疸构成比为8．1％（13／160），低热构成比为5．6％（9／160），皮肤搔痒构成比为4．4％（7／160），无症状者构成比为59．4％（95／160）。临床治愈率为71．3％。结论心血管药、抗肿瘤药和抗生素是引起老年药物性肝损害的常见药物。老年患者肝功能受损后大多无明显症状。老年人肝损伤与其肝药物代谢酶活性降低及长期联合用药有关。

Clinical features of drug-induced liver injury in the elderly

Objective To investigate the clinical features of drug-induced liver injury （DILI） in the elderly, the types of causative agents and principle of prevention. Methods Retrospective analysis was used to study the clinical data obtained from the 160 elderly in-patients with DILI from January 2005 to June 2009. Results The incidence of DILI in the elderly in-patients was 3.17% （160/5047）. The elderly often took several kinds of medicine simultaneously. Among the causative agents, cardiovascular drugs were the most common ones [25.6 % （41/160）], followed by antineoplastics [21.9% （35/160）], and the third was antibiotics [18.1% （29/160）]. The main clinical symptoms of DILI were as follows： fatigue, anorexia, nausea, vomiting [39.4 % （63/160）], jaundice [8.1% （13/160）], low grade fever [5.6% （9/160）] and skin itching [4.4% （7/160）]. Whereas the asymptomatic patients was 59.4% （95/160）. Clinical cure rate was 71.3 % without any cases of hepatic failure. Conclusions The common agents caused the elderly to develop hepatic injury were cardiovascular drugs, antineoplastics and antibiotics. Most of the patients were asymptomatic. The lower activity of liver metabolic enzyme and the long-term combination of drugs were associated with the liver injure in the elderly.