老年人急性药物性肝损伤的病因及临床特点分析

目的探讨老年人急性药物性肝损伤的病因和临床特点。方法回顾性分析2005年10月至2011年5月首都医科大学附属北京地坛医院收治的102例老年急性药物性肝损伤住院患者的病历资料,并与150例中青年急性药物性肝损伤患者进行比较。结果按照国际医学科学组织理事会(CIOMS)分型标准以及RUCAM评分量表,老年组确诊95例,中青年组135例。老年组原发疾病前三位为骨关节疾病(26.3%)、心脑血管疾病(17.9%)、皮肤疾病(12.6%);而中青年组排名前三位的分别是皮肤疾病(20.7%)、使用抗生素及抗真菌药物(13.3%)、结核病(10.4%)。两组患者服用中药比例分别为52.6%、50.4%。老年组主要临床表现包括乏力(67.4%)、纳差(88.1%)、恶心/呕吐(42.15%)、黄疸(77.9%),与中青年组相比无显著性差异。两组均以肝细胞损伤型为主,但老年组胆汁淤积型发生率较中青年组更高(P<0.05)。结论老年患者急性药物性肝损伤的原发疾病谱与中青年不同,胆汁淤积型发生率较中青年更高。

Analysis of etiology and clinical features of acute drug-induced liver injury in the elderly

Objective To explore the etiology and clinical manifestation of acute drug-induced liver injury in the elderly.Methods We performed a retrospective analysis of 102 elderly inpatients with acute drug-induced liver injury in Beijing Ditan Hospital from October 2005 to May 2011,as compared them with 150 cases of young patients.Results According to the diagnostic criteria and classification methods as well as RUCAM scoring system of international consensus meeting,95 cases in the old group and 135 cases in the young group were finally confirmed as acute drug-induced liver injury.The main primary diseases in elderly were bone and joint diseases(26.3%),cardiovascular and cerebrovascular diseases(17.9%),skin diseases(20.7%).But in the young group,the main primary diseases were skin diseases(20.7%),antibiotics and antifungal agents(13.3%),antituberculous drugs(10.4%).Traditional Chinese medicine was taken commonly in both groups,52.6% in the elderly and 50.4% in the young respectively.The clinical manifestations in the elderly included fatigue(67.4%),anorexia(88.1%),nausea/vomiting(42.15%)and jaundice(77.9%),and no significant difference was observed between the two groups.Hepatocellular type was the main type,but cholestasis injury in elderly was more common than in the young group(P<0.05).Conclusions Elderly patients with acute drug-induced liver injury have different primary diseases compared with the young patients,and cholestasis injury was more common.