首页|老年药物性肝损伤患者临床特征分析

老年药物性肝损伤患者临床特征分析

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  • 国家科技期刊平台
  • NETL
  • NSTL
  • 万方数据
目的 分析老年药物性肝损伤(DILI)患者的临床特征，以为临床干预提供依据。方法 2018 年 12 月～2024 年2 月我院老年医学科诊治的老年多种疾病患者 181 例，常规行临床分型和疾病程度分度。应用单因素和多因素Logistic回归分析影响DILI病情严重程度的危险因素。结果 在181 例老年患者中，发现DILI者44 例(24。3％)，其中肝细胞损伤型 28 例，胆汁淤积型 12 例，混合型 4 例;轻度 25 例，中度 10 例，重度 8 例，死亡 1 例;可疑药物为中草药占27。3％，保健类药物占22。7％，内分泌系统疾病用药占 13。6％，心脑血管疾病用药占 11。4％，等;DILI组年龄为 72(66，76)岁，显著大于非DILI组[67(65，69)，P<0。05]，多种疾病、饮酒、脂肪肝和高脂血症占比分别为79。6％、27。3％、56。8％和84。1％，显著高于非DILI组(分别为11。7％、3。6％、12。4％和8。7％，均P<0。05);9 例≥3 级肝损伤患者年龄为73(67，75)岁，显著大于35 例≤2 级肝损伤者[67(66，70)岁，P<0。05]，饮酒、多种疾病和合并脂肪肝占比分别为 88。9％、100。0％和88。9％，均显著大于≤2 级肝损伤者(分别为11。4％，74。3％和48。6％，均P<0。05)，多因素Logistic回归分析表明，高龄[OR:1。67，95％CI:1。26～3。05]、饮酒[OR:2。43，95％CI:1。35～3。17]和脂肪肝[OR:2。14，95％CI:1。50～4。75]均是影响老年DILI患者病情严重程度的独立危险因素(P<0。05)。结论 中草药、保健类药物、内分泌和心脑血管系统疾病用药容易导致老年基础疾病多的患者发生DILI，戒酒、降低脂肪肝程度和控制好疾病发作可能减轻DILI严重程度，值得临床深入研究。
Clinical feature of elderly patients with drug-induced liver injury:An analysis of 44 cases
Objective This study was conducted to summarize clinical feature of elderly patients with drug-induced liver injury(DILI),and to investigate risk factors impacting severity of liver illness.Methods 181 elderly patients with various underlying diseases were encountered in our hospital between December 2018 and February 2024,and DILI was routinely diagnosed,catalogued and liver injury determined.Univariate and multivariate Logistic regression analysis was applied to find risk factors for liver injuries.Results Of 181 elderly patients,DILI was diagnosed in 44 cases(24.3%),including hepatocellular injury in 28 cases,cholestasis in 12 cases and mixed type in 4 cases;there were mild liver injury in 25 cases,moderate in 10 cases,severe in8 cases and dead in1 cases;suspected herbal medicines accounted for 27.3%,health care agents for 22.7%,agents for endocrine diseases for 13.6%and medicines for cardiovascular diseases for 11.4%,etc;ages in patients with DILI was 72(66,76)yr,much greater than[67(65,69)yr,P<0.05]in patients without DILI,percentages of multiple concurrent underlying diseases,alcohol abuse,fatty liver and hyperlipidemia were 79.6%,27.3%,56.8%and 84.1%,all much higher than 11.7%,3.6%,12.4%and 8.7%(all P<0.05)in patients without DILI;ages in 9 patients with liver injury grade 3 or more was73(67,75)yr,much older than[67(66,70)yr,P<0.05]in 35 patients with liver injury of grade 2 or less,percentages of ethanol intake,multiple underlying diseases and concurrent fatty liver was 88.9%,100.0%and 88.9%,all significantly greater than 11.4%,74.3%and 48.6%(all P<0.05)in patients with grade 2 or less liver injuries;multivariate Logisticregressionanalysisshowedthatelderly[OR:1.67,95%CI:1.26-3.05],alcohol abuse[OR:2.43,95%CI:1.35-3.17]and fatty liver[OR:2.14,95%CI:1.50-4.75]were all the risk factors impacting severity of liver injuries in elderly patients with DILI(P<0.05).Conclusion Herbal medicine,health care drugs,agents for endocrine and cardiovascular diseases could lead to DILI occurrence in elderly patients with multiple system diseases,in which drug-drug interactions might involve in this setting,and clinicians should carefully deal with underlying diseases,and prescribe medicines as necessary as possible.

Drug-induced liver injuryUnderlying diseasesClinical featureRisk factorsElderly

李勇、张蕾、吴幸福

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244000 安徽省铜陵市皖南医学院附属铜陵市立医院老年医学科

244000 安徽省铜陵市皖南医学院附属铜陵市立医院呼吸与危重症医学科

药物性肝损伤 基础疾病 危险因素 特征 老年

安徽省自然科学基金青年基金资助项目

2208085QC98

2024

10.3969/j.issn.1672-5069.2024.04.014

实用肝脏病杂志
中华医学会安徽分会

实用肝脏病杂志

CSTPCD
影响因子：1.362
ISSN：1672-5069
年,卷(期)：2024.27(4)