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目的分析不同年龄段患者药物性肝损伤(DILI)的临床特征。方法回顾性分析230例住院治疗的DILI患者临床资料,根据发病年龄分为中青年组(14-59岁,161例)和老年组(≥60岁,69例),对比两组人群起病、DILI相关表现和指标以及治疗转归情况。结果中青年组引起肝损伤的药物前三位为中药、抗生素和心血管药物,老年组前三位为中药、心血管药物和保健品。服药至发病时间老年组较中青年组长[(28.3±18.3)d vs.(21.8±14.4)d](P<0.01)。肝损伤类型中青年组以Ⅰ型和Ⅲ型为主,老年组以Ⅱ型为主(P<0.05)。老年组更易出现食欲下降的症状,中青年组ALT水平升高更明显。老年组Maria评分分布低于中青年组,治疗转归亦较中青年组稍差。结论DILI人群中,中青年和老年基础疾病谱、肝损药物、发病时间存在明显差异。老年组胆汁淤积型损伤更多见,且病情较隐匿,治疗转归较差。
Objective To analyze the clinical features of drug-induced liver injury (DILI) in different age groups. Methods The clinical data of 230 hospitalized patients with DILI were retrospectively analyzed. According to the age of onset, the data were divided into young group (aged 14-59 years, 161 cases) and elderly group (≥60 years old, 69 cases) DILI-related performance and indicators and treatment outcome. Results The first three drugs causing liver damage in middle-aged and young group were traditional Chinese medicine, antibiotics and cardiovascular drugs. The top three in the elderly group were traditional Chinese medicine, cardiovascular drugs and health products. The patients in the elderly group were longer than those in the young group (28.3 ± 18.3 days vs. 21.8 ± 14.4 days, P <0.01). Type Ⅰ and type Ⅲ were the main types of liver injury, and type Ⅱ was the predominant in the elderly group (P <0.05). Elderly group is more prone to symptoms of decreased appetite, elevated ALT levels in young group more obvious. Maria score distribution in the elderly group was lower than that in the middle-aged group, and the treatment outcome was also slightly worse than that in the middle-aged group. Conclusion Among DILI population, there are significant differences in basic disease spectrum, liver damage drug and onset time between young and old. Older cholestatic type injury more common, and the condition is more hidden, the treatment of poor prognosis.