62例老年非病毒性肝损伤患者临床特点和病因分析

Non-viral liver injury in the elderly: clinical analysis of 62 cases

摘要:

目的 探讨老年非病毒性肝损伤患者的临床特点和病因, 指导临床诊断和治疗。方法 回顾性分析62例2006年1月至2009年6月期间复旦大学附属中山医院收治的非病毒（已知甲～戊型肝炎病毒、单纯疱疹病毒、巨细胞病毒、EB病毒和柯萨奇病毒）感染所致的60岁及以上肝功能异常患者的临床资料, 并与98例同期住院的60岁以下成年人非病毒性肝损伤患者进行比较。结果 老年非病毒性肝损伤患者临床表现无特异性, 乏力和纳差的发生率明显高于非老年组（P＜0.05）; 老年组患者中引起肝功能异常的病因以药物性肝病（DILD）居首位（40.32%）, 其它依次为非酒精性脂肪性肝病（NAFLD）（20.97%）、胆源性疾病（17.74%）、心肺功能不全（9.68%）; 丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）在DILD患者中增高最为明显, 老年组DILD患者ALT和AST高于非老年组[ALT:（775.83±478.51）vs（526.44±401.54）U/L, AST:（663.61±464.85）vs（457.45±521.78）U/L; P＜0.01]。引起老年人肝损伤的药物主要是中药（40%）、非甾体类消炎药（12%）和HMG-CoA还原酶抑制剂（12%）。结论 老年非病毒性肝损伤患者以DILD最为多见, 其次为NAFLD和非肝源性疾病导致肝损伤, 临床医师应特别重视老年人药物性肝病的防治。

Abstract:

Objective To analyze the clinical features and causes of non-viral liver injury in elderly patients and improve the diagnosis and treatment. Methods Sixty-two aged patients(≥60 years) with abnormal liver function due to non-viral causes(instead of HAV~HEV, HSV, CMV, EBV and CSV) who were admitted to our hospital from January 2006 to June 2009 were analyzed retrospectively. The clinical data of these patients were compared with that of 98 non-aged patients (＜60 years). Results There was no special symptom in aged patients and the incidences of fatigue, nausea, and jaundice in aged patients were significantly higher than those in non-aged patients. In aged patients, 25 cases were diagnosed as drug-induced liver disease(DILD, 40.32%) which ranked first, 13 cases as non-alcoholic fatty liver disease (NAFLD, 20.97%), 11 cases as gallbladder disease (17.74%), and 6 cases were induced by cardiopulmonary insufficiency(9.68%). The serum levels of ALT and AST were highest in DILD. Compared with non-aged patients, the serum levels of ALT and AST were significantly higher in aged patients [ALT: (775.83±478.51) vs (526.44±401.54)U/L, AST: (663.61±464.85) vs (457.45±521.78)U/L; P＜0.01]. The main agents causing DILD in the elderly included herbal medicine(40%), nonsteroidal anti-inflammatory drugs(12%) and HMG-CoA reductase inhibitors(12%). Conclusion DILD is the most common non-viral liver disease in elerly patients, followed by NAFLD and gallbladder disease caused liver injury. Clinicians should pay more attention to DILD in the elderly.