摘要
目的:分析老年药物性肝损害(DILI)的常见引发药物种类、临床特征、病理特点和预后,以提高对该病的诊治水平。方法:回顾性分析2009年2月～2012年2月72例老年DILI患者资料,对其用药史、临床表现、肝功能、凝血功能、病原学标志、病理表现以及治疗转归进行综合分析。结果:引起老年DILI前5位的药物分别是中药43例(59.8%)、降血糖药8例(11.1%)、心血管药7例(9.7%)、抗菌药6例(8.3%)、抗结核药5例(6.9%)。DILI临床分类:药物性肝衰竭15例(20.8%)、急性药物性肝损害36例(50%)、慢性药物性肝损害17例(23.6%)、药物性肝硬化4例(5.6%)。主要病理改变为肝细胞坏死、肝细胞水样变性、汇管区扩大、肝细胞脂肪变性、纤维组织增生、嗜酸性粒细胞浸润、汇管区或肝窦内混合炎细胞浸润等。72例患者中治愈26例(36.1%),好转31例(43.1%),无效11例(15.3%),死亡4例(5.6%)。结论:老年DILI患者有其不同的引发药物谱,其临床表现和实验室检查缺乏特异性,但死亡率较高。因此,对于老年患者用药应严格把握适应证,密切监测肝功能,早期治疗。
Objective：To investigate the types of causative agents,clinical pathological features,and related prognosis factors of elderly patient with drug-induced liver disease（DILI） in order to improve the diagnosis and treatment of DILI.Methods：72 elderly patients with DILI admitted to our hospital from February 2009 to February 2012 were retrospectively reviewed according to their drug history,clinical features,lab tests,pathological characteristics,and related prognosis factors.Results：The primary etiological drugs of elderly patient with DILI were herbal medicine（59.8%）.hypoglycemic agents（11.1%）,cardiovascular drugs（9.7%）,antibiotics（8.3%）and anti-tuberculosis drugs（6.9%）.Their DILIs were 15 cases of drug-induced liver failure（20.8%%）,36 cases of acute DILI（50%） and 17 cases of chronic DILI （23.6%）,4 cases of drug-induced live cirrhosis（5.6%）,respectively.The predominant pathology of DILI was hepatocyte necrosis,hepatocyte hydropic degeneration,hepatocyte fatty degeneration,hepatic portal area enlargement,fibroplasia,eosinophils infiltration,mixed inflammatory cell infiltration in hepatic portal area or hepatic sinusoid,cholestasis,hepatocyte apoptosis and Kupffer cell proliferation.Conclusion：The DILI in elderly patients had the different types of causative agents but no specific clinical manifestation.Elderly patients with DILI had the higher mortality（5.6%vs 2.6%）.Therefore, their hepatic function should be dynamically monitored in the application of related drugs to diagnose and treat them early.
出处
《药物流行病学杂志》
CAS
2013年第5期242-245,共4页
Chinese Journal of Pharmacoepidemiology
关键词
老年患者
药物性肝损害
临床特征
预后
Elderly patient
Drug-induced liver injury
Clinical features
Prognosis
