老年人药物性肝损伤的临床特点分析

Clinical characteristics of drug-induced liver injury in elderly patients

摘要:

目的 分析老年性药物性肝损伤(DILI)患者的临床特征。方法 回顾性分析2011年1月至2013年12月期间在我院住院治疗的DILI患者528例的临床资料。按年龄分为两组:老年组(>60岁,n＝132)和非老年组(≤60岁,n＝396)。比较两组患者间的临床特征、生化学指标和治疗效果。采用SPSS 16.0软件进行数据处理。计量资料以均数±标准差([AKx-D]±s)表示,组间比较采用t检验。计数资料以百分率表示,组间比较采用χ²检验。结果 老年组中女性患者比例显著低于非老年组(58.3% vs 73.4%,P<0.05)。导致DILI的药物中,中草药(含中成药)占首位,化学药物以非甾体类抗炎药、抗生素和降压药多见。老年组患者治疗前的血清总蛋白[(62.8±7.6) vs(64.6±8.5)g/L]和白蛋白水平[(35.9±4.6) vs(38.0±5.2)g/L]显著低于非老年组(P<0.05)。老年组患者的治疗总有效率显著低于非老年组(91.7% vs 97.0%,P<0.05)。结论 中草药(含中成药)是致老年患者DILI的主要药物,老年与中青年DILI患者的临床表现类似。中青年DILI患者的临床疗效优于老年患者。

Abstract:

Objective To analyze the clinical characteristics of the elderly patients with drug-induced liver injury (DILI). Methods Clinical data of the 528 DILI patients in our hospital from January 2011 to December 2013 were collected and retrospectively analyzed. The patients were divided into aged group (>60 years old, n=132) and non-aged group (≤60 years old, n=396). Clinical features, biochemical indices and treatment outcomes were compared between the 2 groups. SPSS statistics 16.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results The proportion of females was significantly lower in the aged group than the non-aged group (58.3% vs 73.4%, P<0.05). Chinese herbal medicine (including Chinese patent medicine) ranked first in the drugs causing DILI. And for the chemical agents, non-steroid anti-inflammatory drugs, antibiotics and hypotensors were the most common. Before the treatment, the serum levels of total protein (TP) and albumin (ALB) of aged group were significantly lower than those of non-aged group [(62.8±7.6) vs (64.6±8.5)g/L, (35.9±4.6) vs (38.0±5.2)g/L, both P<0.05]. The total effective rate was obviously lower in the aged group than in the non-aged group (91.7% vs 97.0%, P<0.05). Conclusion Chinese herbal medicines (including Chinese patent medicine) are the main drugs causing DILI in the elderly patients. Though the clinical manifestations are similar between the aged and young- and middle-aged patients, the clinical outcomes are better in the latter.