国内老年人药物性肝损伤的临床对照研究文献分析  

Controlled clinical studies on drug-induced liver injury in the elderly Chinese patients： a literature review

作　　者：张颖[1] 张赣生[1] 保志军[1] 郑松柏[1] 于晓峰[1] 

机构地区：[1]复旦大学附属华东医院消化科,上海200040

出　　处：《中华全科医师杂志》2013年第11期890-893,共4页Chinese Journal of General Practitioners

摘　　要：目的 探讨我国老年人药物性肝损伤的发病特点,为临床用药提供参考依据.方法 以“药物性肝损”或“药物性肝病”和“老年”为检索词,检索提取中国生物医学文献数据库（CBM）、中国科技期刊数据库（维普）、万方数据库和中国知网（CNKI）中有关国内老年药物性肝损伤的回顾性对照研究文献,时间从建库至2011年12月,并进行数据整理和统计分析.结果 符合纳入标准的文献5篇,共纳入老年（≥60岁）药物性肝损伤患者275例（老年组）,非老年组602例（对照组）,男女比例分别为0.92∶1和0.95∶1 （P＜0.05）.老年组临床表现以黄疸、乏力、纳差、皮肤瘙痒多见（P＜0.01）,临床分型以胆汁淤积型肝损伤多见[24.9％ （61/245）比18.8％ （102/544）,P＜0.05],对照组则以肝细胞型损伤多见[64.3％ （350/544）比55.1％ （135/245）,P＜0.05].老年组中草药和心血管药物导致药物性肝损伤发生的比例明显高于对照组[分别为47.0％（79/168）比35.9％（93/259）和8.3％ （14/168）比1.2％（3/259）,P＜0.05].老年组治愈好转率为84.4％（141/167）,对照组为81.5％ （291/357）,两组差异无统计学意义（P＞0.05）.结论 老年人对药物敏感性增加,易发生药物性肝损伤,临床医生应予以高度重视,做到规范用药,及早防治.Objective To review the clinical features of drug-induced liver injury （DILI） in elderly Chinese patients.Methods A literature search was conducted with the key words ＂ drug-induced liver injury＂ or ＂ drug-induced liver disease＂ and ＂ elderly＂; four Chinese medical databases were used：including Chinese Biomedical Literature Database （CBM）,Chinese Science and Technology Periodical Database （VIP）,Wanfang Database and China National Knowledge Infrastructure （CNKI）,from when the bases established to December 2011.Data from retrieved literatures of retrospective controlled studies of DILI were analyzed by SPSS 14.0 software.Results Five studies met the inclusion criteria,including 275 elderly patients （aged group） and 602 non-elderly patients （non-aged group） with DILL There was no significant difference in gender between the two groups （P ＞ 0.05）.Clinical manifestations of jaundice,fatigue,anorexia,and skin itching were more commonly seen in the aged group （P ＜ 0.01）.Cholestatic hepatic injury occurred more frequently in the aged group than in the non-aged group [24.9％ （61/245） vs.18.8％ （102/245）,P ＜ 0.05],while hepatocellular type occurred more frequently in the non-aged group [64.3％ （350/544） vs.55.1％ （135/245）,P ＜ 0.05].More DILI were induced by Chinese herb medicine and cardiovascular drugs in the aged group than in the non-aged group [47.0％ （79/168） vs.35.9％ （93/254） and 8.3％ （14/168） vs 1.2％ （3/259） respectively,P ＜ 0.05].As for the prognosis,there was no significant difference in clinical cure and improvement rate between the two groups [84.4％ （141/167） vs.81.5％ （291/357）,P ＞0.05].Conclusion The elderly are more sensitive to the drugs and have a high risk of DILI.Prevention and timely diagnosis and treatment of DILI are particularly important for elderly patients.

关 键 词：回顾性研究 药物性肝损伤 老年人 

分 类 号：R595.3[医药卫生—内科学]