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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。
Objective To investigate the etiology and clinical features of acute drug-induced liver injury in the elderly. Methods A retrospective analysis was performed on 102 medical records of hospitalized patients with acute medical liver injury admitted to Beijing Ditan Hospital, Capital Medical University from October 2005 to May 2011, and compared with 150 cases of young patients with acute drug-induced liver injury . Results According to the classification criteria of International Organization for Medical Sciences (CIOMS) and the RUCAM scale, 95 cases were diagnosed in the elderly group and 135 cases were in the middle-aged and young group. In the elderly group, the top three primary diseases were osteoarthrosis (26.3%), cardiovascular and cerebrovascular diseases (17.9%) and skin diseases (12.6%). The top three middle-aged and young people were skin diseases (20.7% , Antibiotics and antifungal drugs (13.3%) and tuberculosis (10.4%). The two groups of patients taking traditional Chinese medicine were 52.6%, 50.4%. The main clinical manifestations of the elderly group were fatigue (67.4%), anorexia (88.1%), nausea / vomiting (42.15%) and jaundice (77.9%). There was no significant difference between the elderly group and the young group. The two groups were mainly hepatocellular injury, but the incidence of cholestasis in the elderly group was higher than that in the middle-aged group (P <0.05). Conclusions The primary disease spectrum of acute drug-induced liver injury in elderly patients is different from that of middle-aged and young people. The incidence of cholestasis is higher than that of middle-aged and young people.