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老年药物性肝衰竭65例临床特征分析

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

王丽苹, 何婷婷, 崔延飞, 等. 老年药物性肝衰竭65例临床特征分析[J]. 临床肝胆病杂志, 2021, 37(7): 1626-1631. DOI: 10.3969/j.issn.1001-5256.2021.07.029
引用本文: 王丽苹, 何婷婷, 崔延飞, 等. 老年药物性肝衰竭65例临床特征分析[J]. 临床肝胆病杂志, 2021, 37(7): 1626-1631. DOI: 10.3969/j.issn.1001-5256.2021.07.029
WANG LP, HE TT, CUI YF, et al. Clinical features of elderly patients with drug-induced liver failure: An analysis of 65 cases[J]. J Clin Hepatol, 2021, 37(7): 1626-1631. DOI: 10.3969/j.issn.1001-5256.2021.07.029
Citation: WANG LP, HE TT, CUI YF, et al. Clinical features of elderly patients with drug-induced liver failure: An analysis of 65 cases[J]. J Clin Hepatol, 2021, 37(7): 1626-1631. DOI: 10.3969/j.issn.1001-5256.2021.07.029

老年药物性肝衰竭65例临床特征分析

DOI: 10.3969/j.issn.1001-5256.2021.07.029
基金项目: 

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

详细信息
    通讯作者:

    王睿林,wrl7905@163.com

  • 中图分类号: R575.3

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

  • 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χ2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(χ2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。

     

  • 表  1  65例DILF患者实验室指标

    项目 ALF组(n=12) SALF组(n=53) 统计值 P
    男/女(例) 4/8 13/40 χ2=0.069 0.717
    年龄(岁) 66.50(61.50~73.75) 66.00(63.00~68.50) Z=-0.415 0.678
    Alb(g/L) 29.08±5.20 26.36±4.37 t=1.183 0.064
    TBil(μmol/L) 285.94±192.00 313.65±141.67 t=-0.572 0.570
    ALT(U/L) 98.50(36.75~155.75) 142.00(41.50~334.50) Z=0.888 0.375
    AST(U/L) 101.50(54.25~174.25) 174.00(103.50~468.50) Z=2.198 0.028
    GGT(U/L) 100.00(37.75~179.25) 59.00(35.00~90.50) Z=-1.319 0.187
    ChE(U/L) 2 728.00(1 269.00~3 375.00) 2 012.00(1 464.00~3 335.50) Z=-0.406 0.685
    LDH(U/L) 248.00(184.50~300.25) 268.00(224.00~366.00) Z=1.505 0.132
    BUN(mmol/L) 5.60(3.48~20.18) 8.50(3.85~16.60) Z=0.457 0.648
    Scr(μmol/L) 81.00(61.50~107.75) 103.00(76.00~173.00) Z=1.285 0.199
    UA(μmol/L) 159.00(128.25~303.50) 201.00(112.00~325.50) Z=0.600 0.548
    PTA(%) 48.95(39.90~66.75) 29.80(25.05~35.65) Z=-5.377 <0.001
    INR 1.46(1.27~1.62) 1.94(1.75~2.29) Z=4.465 <0.001
    血氨(μmol/L) 50.00(25.00~77.00) 50.00(37.00~92.50) Z=0.739 0.460
    注:LDH,乳酸脱氢酶;UA,尿酸。
    下载: 导出CSV

    表  2  65例DILF患者临床分型及并发症比较

    项目 治疗有效组(n=26) 治疗无效组(n=39) 统计值 P
    年龄(岁) 67.12±5.03 66.90±6.13 t=0.150 0.881
    性别[例(%)] χ2=3.399 0.065
        男 10(38.5) 7(17.9)
        女 16(61.5) 32(82.1)
    临床分型[例(%)]
        胆汁淤积型 11(42.3) 15(38.5) χ2=0.096 0.756
        肝细胞损伤型 7(26.9) 15(38.5) χ2=0.928 0.335
        混合型 8(30.8) 9(23.1) χ2=0.478 0.489
    无胸腹水[例(%)] 2(7.7) 5(12.8) 0.693
    胸腹水[例(%)] 16(61.5) 11(28.2) χ2=7.138 0.011
    单纯胸水[例(%)] 8(30.8) 20(51.3) χ2=2.677 0.102
    单纯腹水[例(%)] 0 3(7.7) 0.269
    电解质紊乱[例(%)] 21(80.8) 36(92.3) 0.250
    消化道出血[例(%)] 2(7.7) 8(20.5) 0.293
    肝肾综合征[例(%)] 5(19.2) 22(56.4) χ2=8.880 0.003
    感染[例(%)]
        肺部感染 10(38.5) 18(46.2) χ2=0.376 0.540
        腹膜炎 7(26.9) 16(41.0) χ2=1.357 0.244
        泌尿系感染 2(7.7) 2(5.1) 1.000
        口腔感染 2(7.7) 4(10.3) 1.000
    HE[例(%)]
        无HE 21(80.8) 12(30.8) χ2=15.604 <0.001
        HE 1期 4(15.4) 11(28.2) χ2=1.444 0.229
        HE 2期 1(3.8) 3(7.7) 0.644
        HE 3期 0 5(12.8) 0.078
        HE 4期 0 8(20.5) 0.018
    下载: 导出CSV

    表  3  65例DILF患者基础疾病情况

    项目 所有患者 治疗有效组(n=26) 治疗无效组(n=39) P
    高血压病[例(%)] 15(23.1) 5(19.2) 10(25.6) 0.548
    冠心病[例(%)] 9(13.8) 2(7.7) 7(17.9) 0.420
    糖尿病[例(%)] 11(16.9) 6(23.1) 5(12.8) 0.458
    脑梗塞[例(%)] 7(10.8) 3(11.5) 4(10.3) 1.000
    肿瘤[例(%)] 9(13.8) 3(11.5) 6(15.4) 0.731
    慢性阻塞性肺疾病[例(%)] 4(6.2) 1(3.8) 3(7.7) 0.644
    结核[例(%)] 5(7.7) 2(7.7) 3(7.7) 1.000
    皮肤病[例(%)] 7(10.8) 3(11.5) 4(10.3) 1.000
    胆道疾病[例(%)] 9(13.8) 5(19.2) 4(10.3) 0.509
    下载: 导出CSV

    表  4  65例老年DILF患者的药物使用情况

    药物类别 二级分类 例数 构成比(%) 具体用药
    化学药 心脑血管药 7 10.8 阿托伐他汀钙、氟伐他丁、胺碘酮、奎尼丁
    降压药 6 9.2 倍他乐克、硝苯地平、卡托普利、依那普利
    抗生素 5 7.7 克林霉素、阿奇霉素、螺旋霉素、洛美沙星、阿莫西林-克拉维酸盐
    抗结核 5 7.7 异烟肼、利福平、吡嗪酰胺、乙胺丁醇、利福喷丁
    解热镇痛药 5 7.7 含对乙酰氨基酚(感康/扑热息痛/快克/感冒灵/速效感冒胶囊)、尼美舒利、布洛芬、安乃近
    抗肿瘤药 5 7.7 环磷酰胺、卡铂、吉西他滨
    神经用药 4 6.2 盐酸帕罗西汀、利培酮、米氮平、佳乐定
    降糖药 4 6.2 格列吡嗪、格列本脲、二甲双胍
    免疫抑制剂 2 3.1 来氟米特、柳氮磺吡啶
    中药类 中草药 15 23.1 何首乌、土三七、补骨脂、雷公藤等
    中成药 23 35.4 脑血康胶囊、复方丹参片、银杏叶滴丸、天麻首乌胶囊、血府逐瘀胶囊、养血清脑颗粒、心元胶囊、安神补心胶囊、牛黄降压丸、决明降酯片、宫瘤消胶囊、金乌骨通胶囊、仙灵骨葆、血脂康、前列通、正胃片、三九胃泰、清开灵、百消丸、独一味胶囊、摩罗丹、肠胃宁、白癜灵
    生物制剂 保健品 13 20.0 长寿因子酒、延寿片、鲅鱼油、西洋参
    其他 5 7.7 染发剂、油漆
    下载: 导出CSV
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    段英, 邢卉春, 王笑梅, 等. 药物性亚急性肝衰竭临床特点及预后[J/CD]. 中华实验和临床感染病杂志(电子版), 2012, 6(3): 217-220. DOI: 10.3877/cma.j.issn.1674-1358.2012.03.010.
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  • 收稿日期:  2020-10-06
  • 修回日期:  2021-01-15
  • 刊出日期:  2021-07-20
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