老年药物性肝损伤的研究进展
Research Progress on Drug-Induced Liver Injury in the Elderly
DOI: 10.12677/ACM.2023.13122776, PDF,   
作者: 谭 辉, 凌 宁：重庆医科大学附属第二医院感染科，重庆
关键词: 药物性肝损伤；老年；临床特征；Drug-Induced Liver Injury； Old Pople； Clinical Features
摘要: 药物性肝损伤是由药物及其代谢产物等所引起的肝脏损伤，是临床常见的不良反应之一，其可引起各种急性、慢性肝病，导致肝衰竭，甚至死亡，严重威胁人们的健康。由于药物性肝损伤发病机制复杂，临床表现多样，缺乏特异性生物诊断标志物，防治难度较大，已受到更多的关注。随着我国人口老龄化的趋势和疾病谱的改变、新药的应用、保健品和中药的滥用、老年人生理功能减退、合并基础疾病，使老年人发生药物性肝损伤的风险增加。基于此，本文从老年药物性肝损伤的流行病学、分型和易感因素、临床表现、常见药物等方面介绍其特点。
Abstract: Drug-induced liver injury is the liver injury caused by drugs and their metabolites, is one of the common clinical adverse reactions, it can cause a variety of acute, chronic liver disease, leading to liver failure, and even death, a serious threat to people’s health. Due to the complex pathogenesis of drug-induced liver injury, diverse clinical manifestations, lack of specific biodiagnostic markers, and great difficulty in prevention and treatment, it has received more attention. With the trend of population aging in China and the change of disease spectrum, the application of new drugs, the abuse of health care products and traditional Chinese medicine, the decline of physiological function in the elderly, and the combined basic diseases, the risk of drug-induced liver injury in the elderly increases. Based on this, this paper introduces the characteristics of drug-induced liver injury from the epidemiology, classification and susceptibility factors, clinical manifestations and common drugs in the elderly.
文章引用：谭辉, 凌宁. 老年药物性肝损伤的研究进展[J]. 临床医学进展, 2023, 13(12): 19725-19731. https://doi.org/10.12677/ACM.2023.13122776

参考文献

[1] 中华医学会, 中华医学会杂志社, 中华医学会消化病学分会, 中华医学会全科医学分会, 中华医学会《中华全科医师杂志》编辑委员会, 消化系统疾病基层诊疗指南编写专家组. 药物性肝损伤基层诊疗指南(2019年) [J]. 中华全科医师杂志, 2020, 19(10): 868-875.
[2] Yao, K.Y., Zhang, S.Q., Jin, R., et al. (2023) Comparative Study on Date Set of Drug-Induced Liver Injury. Chinese Journal of Pharmacovigilance, 20, 568-573.
[3] Li, X., Tang, J. and Mao, Y. (2022) Incidence and Risk Factors of Drug-Induced Liver Injury. Liver International, 42, 1999-2014. [Google Scholar] [CrossRef] [PubMed]
[4] 沈弢, 黄昕, 王誉雅, 庄辉. 我国药物性肝损伤流行病学研究现状[J]. 临床肝胆病杂志, 2018, 34(6): 1152-1155.
[5] Shen, T., Liu, Y., Shang, J., et al. (2019) Incidence and Etiology of Drug-Induced Liver Injury in Mainland China. Gastroenterology, 156, 2230-2241. [Google Scholar] [CrossRef] [PubMed]
[6] Sgro, C., Clinard, F., Ouazir, K., et al. (2002) Incidence of Drug-Induced Hepatic Injuries: A French Population-Based Study. Hepatology, 36, 451-455. [Google Scholar] [CrossRef] [PubMed]
[7] Björnsson, E.S., Bergmann, O.M., Björnsson, H.K., et al. (2013) In-cidence, Presentation, and Outcomes in Patients with Drug-Induced Liver Injury in the General Population of Iceland. Gastroenterology, 144, 1419-1425.E3. [Google Scholar] [CrossRef] [PubMed]
[8] Abajo, F.J.D., Montero, D., Madurga, M. and García Rodríguez, L.A. (2015) Acute and Clinically Relevant Drug-Induced Liver Injury: A Population Based Case-Control Study. British Journal of Clinical Pharmacology, 58, 71-80. [Google Scholar] [CrossRef] [PubMed]
[9] Vega, M., Verma, M., Beswick, D., et al. (2017) The Inci-dence of Drug- and Herbal and Dietary Supplement-Induced Liver Injury: Preliminary Findings from Gastroenterolo-gist-Based Surveillance in the Population of the State of Delaware. Drug Safety, 40, 783-787. [Google Scholar] [CrossRef] [PubMed]
[10] 刘玉兰, 王晶桐. 老年人药物性肝损害的诊治[J]. 中华老年医学杂志, 2009, 28(4): 274-275.
[11] Mitchell, S.J. and Hilmer, S.N. (2010) Drug-Induced Liver Injury in Older Adults. Therapeutic Advances in Drug Safety, 1, 65-77. [Google Scholar] [CrossRef] [PubMed]
[12] 袁玲, 杨永耿, 马颖才. 老年人药物性肝损伤临床特点分析[J]. 肝脏, 2021, 26(4): 442-443, 463.
[13] 李亚飞, 闫华楠, 韩少静, 郭永泽, 韩书香, 李淑霞, 吉丽, 张宏伟. 老年急性药物性肝损伤临床特征及预后影响因素分析[J]. 肝脏, 2020, 25(3): 319-322.
[14] 中华医学会肝病学分会药物性肝病学组. 药物性肝损伤诊治指南[J]. 中华肝脏病杂志, 2015, 23(11): 810-820.
[15] 中华中医药学会肝胆病分会, 中华中医药学会中成药分会. 中草药相关肝损伤临床诊疗指南[J]. 中国中药杂志, 2016, 41(7): 1165-1172.
[16] European Association for the Study of the Liver (2019) EASL Clinical Practice Guide Lines: Drug-Induced Liver Injury. Journal of Hepatology, 70, 1222-1261. [Google Scholar] [CrossRef] [PubMed]
[17] 王丽苹, 何婷婷, 崔延飞, 等. 解放军总医院第五医学中心2009年-2019年老年药物性肝损伤患者的临床特征及变化趋势[J]. 临床肝胆病杂志, 2020, 36(10): 2248-2252.
[18] Council for International Organizations of Medical Sciences (CIOMS) (2020) Drug-Induced Liver In-jury(DILI): Current Status and Future Directions for Drug Development and the Post-Market Setting. A Consensus by a CIOMS Working Group. Geneva.
[19] 任慧琼, 姚均迪, 赵红信, 等. 基于RUCAM评估量表的高龄老年药物性肝损伤162例临床分析[J]. 肝脏, 2021, 26(11): 1276-1278.
[20] 杨雪, 涂荣芳, 杨晋辉. 498例药物性肝损伤患者的临床特点及其预后分析[J]. 中华肝脏病杂志, 2022, 30(7): 735-740.
[21] 郭甜甜, 马子坤, 王昱, 等. 老年药物性肝损伤的临床特征及预后分析[J]. 药物不良反应杂志, 2023, 25(6): 345-351.
[22] 张平, 柯玉满, 樊小春, 等. 药物性肝损伤临床分析324例[J]. 世界华人消化杂志, 2013, 21(33): 3720-3723.
[23] Chalasani, N., Bonkovsky, H.L., Fontana, R., et al. (2015) Features and Outcomes of 899 Patients with Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology, 148, 1340-1352. [Google Scholar] [CrossRef] [PubMed]
[24] Lucena, M.I., et al. (2009) Phenotypic Characterization of Idio-syncratic Drug-Induced Liver Injury: The Influence of Age and Sex. Hepatology, 49, 2001-2009. [Google Scholar] [CrossRef] [PubMed]
[25] Reuben, A., Koch, D.G. and Lee, W.M. (2010) Drug-Induced Acute Liver Failure: Results of a U.S. Multicenter, Prospective Study. Hepatology, 52, 2065-2076. [Google Scholar] [CrossRef] [PubMed]
[26] Hoofnagle, J.H. and Björnsson, E.S. (2019) Drug-Induced Liver Injury: Types and Phenotypes. The New England Journal of Medicine, 381, 264-273. [Google Scholar] [CrossRef] 
[27] O’donohue, J., Oien, K.A., Donaldson, P., et al. (2000) Co-Amoxiclav Jaundice: Clinical and Histological Features and HLA Class II Association. Gut, 47, 717-720. [Google Scholar] [CrossRef] [PubMed]
[28] Donaldson, P.T., Daly, A.K., Henderson, J., et al. (2010) Human Leu-cocyte Antigen Class II Genotype in Susceptibility and Resistance to Co-Amoxiclav-Induced Liver Injury. Journal of Hepatology, 53, 1049-1053. [Google Scholar] [CrossRef] [PubMed]
[29] Li, C.P., Rao, T., Chen, X.P., et al. (2019) HLA-B*35: 01 Allele Is a Potential Biomarker for Predicting Polygonum Multiflorum-Induced Liver Injury in Humans. Hepatology, 70, 346-357. [Google Scholar] [CrossRef] [PubMed]
[30] Hunt, C.M., Yuen, N.A., Stirnadel-Farrant, H.A. and Suzuki, A. (2014) Age-Related Differences in Reporting of Drug-Associated Liver Injury: Data-Mining of WHO Safety Report Database. Regulatory Toxicology and Pharmacology, 70, 519-526. [Google Scholar] [CrossRef] [PubMed]
[31] 丁惠国. 重视老年人药物性肝损伤[J]. 药物不良反应杂志, 2014(3): 132-133.
[32] 崔金英. 老年人常见药物性肝损伤研究进展[J]. 中国误诊学杂志, 2017(5): 116-118.
[33] 赵欢, 刘建秋, 薛鹏. 石家庄社区老年多重用药患者生命质量及其影响因素[J]. 中国老年医学杂志, 2013, 33(5): 1137-1139.
[34] Tulner, L.R., Kuper, I.M., Frankfort, S.V., et al. (2009) Discrepancies in Reported Drug Use in Geriatric Outpatients: Relevance to Adverse Events and Drug-Drug In-teractions. The American Journal of Geriatric Pharmacotherapy, 7, 93-104. [Google Scholar] [CrossRef] [PubMed]
[35] Juniius-Walker, U., Theile, G. and Hummers-Pradier, E. (2007) Prevalence and Predictors of Polypharmacy among Older Primary Care Patients in Germany. Family Practice, 24, 14-19. [Google Scholar] [CrossRef] [PubMed]
[36] Kong, X., Guo, D., Liu, S., Zhu, Y. and Yu, C.X. (2021) Inci-dence, Characteristics and Risk Factors for Drug-Induced Liver Injury in Hospitalized Patients: A Matched Case-Control Study. British Journal of Clinical Pharmacology, 87, 4304-4312. [Google Scholar] [CrossRef] [PubMed]
[37] Weersink, R.A., Alvarez-Alvarez, I., Medina-Cáliz, I., et al. (2021) Clinical Characteristics and Outcome of Drug-Induced Liver Injury in the Older Patients: From the Young-Old to the Oldest-Old. Clinical Pharmacology & Therapeutics, 109, 1147-1158. [Google Scholar] [CrossRef] [PubMed]
[38] Byeon, J.H., Kil, J.H., Ahn, Y.C. and Son, C.G. (2019) Systematic Review of Published Data on Herb Induced Liver Injury. Journal of Ethnopharmacology, 233, 190-196. [Google Scholar] [CrossRef] [PubMed]
[39] 姬琛华, 张竹青, 王晓媛, 卢书明. 老年药物性肝损伤患者临床特征分析[J]. 临床肝胆病杂志, 2017(3): 502-506.
[40] 彭朋, 元唯安. 中药药源性肝毒性的研究进展[J]. 药物评价研究, 2021, 44(8): 1783-1792.
[41] He, S., Zhang, C., Zhou, P., et al. (2019) Herb-Induced Liver Injury: Phylogenetic Relationship, Structure-Toxicity Relationship, and Herb-Ingredient Network Analysis. International Journal of Molecular Sciences, 20, Article 3633. [Google Scholar] [CrossRef] [PubMed]
[42] 蒋美纯, 朱萱. 他汀类药物治疗慢性肝病有效性及安全性研究进展[J]. 中国实用内科杂志, 2020, 40(5): 423-427.
[43] 陆玮婷, 李军, 欧宁, 等. 276例药物性肝损伤的病因和临床表现分析[J]. 中华肝脏病杂志, 2006, 14(11): 832-834.
[44] 王亚南. 药物性肝损伤78例临床分析[J]. 青岛医药卫生, 2022, 54(5): 325-329.

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