老年药物性肝衰竭65例临床特征分析  

Clinical features of elderly patients with drug-induced liver failure:An analysis of 65 cases

作　　者：王丽苹 何婷婷 崔延飞 王仲霞 朱云 景婧 孙永强 许文涛 余思邈 桑秀秀 田淼 王立福 王睿林 WANG Liping;HE Tingting;CUI Yanfei;WANG Zhongxia;ZHU Yun;JING Jing;SUN Yongqiang;XU Wentao;YU Simiao;SANG Xiuxiu;TIAN Miao;WANG Lifu;WANG Ruilin(Department of Hepatology of Traditional Chinese Medicine,The Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Hepatology and Spleen-Stomach,The First Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]解放军总医院第五医学中心中医肝病科,北京100039 [2]河南中医药大学第一附属医院脾胃肝胆科,郑州450000

出　　处：《临床肝胆病杂志》2021年第7期1626-1631,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金(81673806);中国医药教育协会2020重大科学攻关问题和医药技术难题科研课题(2020KTY001)。

摘　　要：目的了解老年药物性肝衰竭(DILF)的疾病特征及用药情况,为临床防治老年DILF提供参考。方法选取2015年1月—2019年12月于解放军总医院第五医学中心明确诊断为DILF且年龄≥60岁的患者65例,按临床疗效判定标准进行分组,治愈和好转为治疗有效组,无效和死亡为治疗无效组。统计分析老年DILF患者的年龄、性别、基础疾病、用药种类、临床分型、并发症及预后等临床资料。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ^(2)检验或Fisher精确检验。结果65例老年DILF患者中,男17例(26.2%),女48例(73.8%),男女比例1∶2.82,老年DILF分型以亚急性肝衰竭为主(81.5%),临床分型以胆汁淤积型多见(40%)。治疗有效组共26例(40%),治疗无效组共39例(60%)。在并发症方面,治疗有效组胸腹水比例高于无效组(61.5%vs 28.2%),肝肾综合征比例低于无效组(19.2%vs 56.4%),未合并肝性脑病比例高于无效组(80.8%vs 30.8%),合并肝性脑病4期比例低于无效组(0 vs 20.5%),差异均有统计学意义(χ^(2)值分别为7.138、8.880、15.604,P值均<0.05)。引起DILF的主要药物包括:化学类以心脑血管药物(10.8%)为主,其次是降压药(9.2%)和抗生素(7.7%);中药类主要为中成药(35.4%)和中草药(23.1%);生物制剂中以保健品多见(20.0%)。结论老年DILF以亚急性肝衰竭多见,临床分型以胆汁淤积型为主,并发肝性脑病及肝肾综合征易导致预后不佳。Objective To investigate the features and medication of elderly patients with drug-induced liver failure(DILF),and to provide a reference for clinical prevention and treatment of DILF in elderly patients.Methods A total of 65 elderly patients,aged≥60 years,who were diagnosed with DILF in The Fifth Medical Center of Chinese PLA General Hospital from January 2015 to December 2019 were enrolled and divided into groups based on the criteria for clinical outcome evaluation.The patients who were cured or improved were enrolled as response group,and those who had no response or died were enrolled as non-response group.Related clinical data were collected and analyzed,including age,sex,underlying diseases,type of the drug used,clinical classification,complications,and prognosis.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.Results Among the 65 elderly patients with DILF,there were 17 male patients(26.2%)and 48 female patients(73.8%),with a male/female ratio of 1∶2.82.Subacute liver failure(SALF)was the main type of DILF in the elderly patients(81.5%),and cholestasis type was the most common clinical type(40%).There were 26 patients in the response group and 39 in the non-response group,accounting for 40%and 60%,respectively,of all patients.As for complications,compared with the non-response group,the response group had a significantly higher proportion of patients with pleuroperitoneal fluid(61.5%vs 28.2%,P<0.05),a significantly lower proportion of patients with hepatorenal syndrome(19.2%vs 56.4%,P<0.05),a significantly higher proportion of patients without hepatic encephalopathy(80.8%vs 30.8%,P<0.05),and a significantly lower proportion of patients with stage 4 hepatic encephalopathy(0 vs 20.5%,P<0.05).The main drugs causing DILF included cardiovascular and cerebrovascular drugs(10.8%),antihypertensive drugs(9.2%),and antibiotics(7.7%);traditional C

关 键 词：化学性与药物性肝损伤 肝功能衰竭 体征和症状 

分 类 号：R575.3[医药卫生—消化系统]