不同年龄非酒精性脂肪性肝病合并急性药物性肝损伤患者的临床特点分析  

Clinical characteristics of non-alcoholic fatty liver disease patients with concurrent acute drug-induced liver injury across varied age cohorts

作　　者：张思敏 袁乙富 吴小溪 杜晟楠 曹勤[2] 蒋元烨[1] ZHANG Si-min;YUAN Yi-fu;WU Xiao-xi;DU Sheng-nan;CAO Qin;JIANG Yuan-ye(Education Planning and Training Department,Putuo Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China;Department of Gastroenterology,Putuo Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China)

机构地区：[1]上海中医药大学附属普陀医院教育规培科,200062 [2]上海中医药大学附属普陀医院消化内科,200062

出　　处：《肝脏》2023年第9期1088-1092,共5页Chinese Hepatology

基　　金：上海市自然科学基金(22ZR1455900);上海市卫计委临床研究专项面上项目(201940449);上海市普陀区卫生健康系统科技创新项目重点项目(ptkwws202201);上海中医药大学后备卓越中医人才项目(20D-RC-02);上海市名中医沈红权普陀传承工作室(ptzygzs2201,SHGZS-202224);上海市普陀区杏林优青人才培养计划(ptxlyq2201);上海市普陀区卫生健康系统特色专病建设项目(2023tszb01)。

摘　　要：目的探讨非酒精性脂肪肝(NAFLD)合并急性药物性肝损伤(DILI)患者的临床特点。方法选取上海中医药大学附属普陀医院2020年至2022年住院及门诊治疗的68例NAFLD合并急性DILI临床患者的一般资料、既往使用药物资料及实验室数据,进行统计分析。结果导致急性DILI的前五位药物依次为心血管系统药、非甾体消炎药、抗痛风药、糖尿病药、抗肿瘤药。65例(95.59%)临床评估为1级(轻度)。青中年组ALT高于老年组,为88(60.5)U/L比58.5(24.25)U/L(P<0.01);青中年组HDL、Apo A指标低于老年组,为1.09(0.3525)μmol/L比1.21(0.3425)μmol/L、(1.15±0.27)g/L比(1.34±0.22)g/L(P<0.05),Apo B指标高于老年组,为0.88(0.28)g/L比0.74(0.27)g/L(P<0.05)。青中年组N低于老年组,为(52.17±9.3)%比(57.94±9.05)%(P<0.05),而L、PLT高于老年组为(36.11±8.93)%比(30.86±8.56)%、248.5(63.75)×10^(9)/L比205.5(69.25)×10^(9)/L(P<0.05)。结论NAFLD合并急性DILI患者临床以轻度肝损伤为主;与青中年人群相比,老年NAFLD患者发生急性DILI的概率更大,但总体损伤程度与年龄无直接相关性。诱发急性DILI的药物可能与老年基础疾病用药相关。Objective The clinical characteristics of patients with nonalcoholic fatty liver disease(NAFLD)complicated by acute drug-induced liver injury(DILI)were analyzed retrospectively to furnish both clinical and experimental frameworks for guiding therapeutic drug choices in NAFLD patients.Methods In this retrospective analysis,the general demographics,medication utilization patterns,and laboratory data for a cohort of 68 patients diagnosed with NAFLD concomitant with DILI in our hospital between the years 2020 to 2022 were statistically analyzed.Results The sample comprised 32 males and 36 females,with an age range spanning 24 to 82 years.The cohort included 44 elderly patients and 24 middle-aged individuls.The primary medications imlicated in acute DILI were cardiovascular drugs,followed by non-steroidal anti-inflammatory drugs,anti-gout medications,antidiabetic agents,and anti-tumor drugs.With respect to the clinical severity of DILI,the majority of cases were catogorized as Grade 1(mild),accounting for 65 patients(95.59%).In terms of liver function,the ALT levels were notably elevated in the young and middle-aged group as compared to the elderly cohort[88(60.5)U/L vs.58.5(24.25)U/L,P<0.01];Lipid profile analyses revealed that levels of HDL and Apo A were significantly lower in the middle-aged group compared to the elderly[1.09(0.3525)μmol/L vs.1.21(0.3425)μmol/L and 1.15±0.27 g/L vs.1.34±0.22 g/L,P<0.05,P<0.01].Converstly,Apo B levels were elevated in the middle-age cohort[0.88(0.28)g/L vs.0.74(0.27)g/L,P<0.05].From a hematological standpoint,the percentage of neutrophils(N)was lower in the middle-aged group compared to the elderly group[52.17±9.3%vs.57.94±9.05%,P<0.05],whereas levels of lymphocyes(L)and platelets(PLT)were significantly higher[36.11±8.93%vs.30.86±8.56%,and 248.5(63.75)]×10^(9)/L vs.205.5(69.25)×10^(9)/L,P<0.05,P<0.01].Conclusion Mild liver injury emerged as the predominat clinical manifestation among NAFLD patients experiencing acute DILI.Interestingle,while elderly NAFLD patients appeare

关 键 词：非酒精性脂肪性肝病 急性药物性肝损伤 临床特点 

分 类 号：R575.5[医药卫生—消化系统]