Clinical analysis of drug-induced liver injury in the elderly / 中华老年医学杂志

Objective To investigate the causes, clinical features, classifications and liver function change of drug-induced liver damage (DILD) in the elderly. Methods One hundred and sixty seven inpatients with acute drug-induced liver injury in our hospital in the past ten years (January 2000 to December 2009) were retrospectively investigated,and the diagnosis and classification methods of acute DILD were based on international consensus meeting (international criteria). Results Among 167 DILI cases, there were 53 cases (31.7%) in the older group and 114 cases (68.3%) in middle-youth age group. Fatigue and jaundice were the more common symptoms, accounting for 50.3% and 46.7%, respectively. In 167 cases, no obvious symptoms and signs were shown in 25 cases. There were no significance differences in clinical manifestation between two groups. Many drugs could induce liver injury. The most common drugs inducing DILD were Chinese traditional and herbal drugs, accounting for 47.9%. Drugs used in heart diseases and inducing liver injury were more common in the older group. In this study, 40 (75.5%), 5 (9.4%) and 8 (15.1%) cases were designated as hepatocellular, cholestetic and mixed DILD in the older group, and 91 (78.9%), 8 (7.4%) and 15 (13.7%) in middle-youth age group, respectively. There were no significance differences between two groups in classifications. Conclusions Many drugs could cause liver injury. The symptoms of acute DILD are nonspecific. Drugs used in heart diseases and inducing liver injury are more common in older patients.

Analysis of correlation between intestinal microflora and intestinal mucosa immune in the elderly / 中华老年医学杂志

Objective To investigate the characteristics of intestinal microflora and its effect on fecal secretory immunoglobulin A (sIgA) in the elderly. Methods All 104 cases were assigned to two groups: the control group (healthy adults, age<60 years ,n=36) and the elderly group (healthy elderly persons, age ≥60 years, n=68). Feces samples of all cases were cultured under both aerobic and anaerobic conditions for the 6 bacteria (4 kinds of anaerobes and 2 kinds of aerobes) and the yeasts. The ratio of bifidobaeterium to Enterobacteria (the ratio of B/E) was calculated, which reflected personal colonization resistance. The fecal sIgA was also measured. Results Compared with control group, the number of fecal bifidobacterium and the ratio of B/E were significantly decreased in elderly group[(9.1±1.1)vs. (10.2±0.8)lgCFU/g,P<0. 01 ;(1. 02±0.14) vs. (1.24± 0. 18), P < 0. 01], and the number of enterobacteria and peptostreptococcus was significantly increased in elderly group [(9.2±1.3) vs. (8. 2±0.7) lgCFU/g, P < 0. 05 ; (8. 5 ±1.4) vs. (7.1 ± 1.6)lgCFU/g, P<0. 05]. The fecal slgA was much lower than that in control group [(652.9± 184.3) vs. (793. 5±150. 3)μg/ml, P<0. 05]. Moreover, the quantity change of bifidobacterium was correlated with the concentration of fecal sIgA(r=0. 562, P<0. 01). Conclusions The number of fecal bifidobacterium is significantly decreased, while the number of enterobacteria and peptostreptococcus is significantly increased in elderly persons. The colonization resistance is significantly decreased and the intestinal immuno-barrier function is injuried in elderly persons, which have influenced the intestinal microflora.

Effect of Microecologics on the Intestinal Bacterial Overgrowth and Bacterial Translocation in Cirrhotic Rats / 医学研究杂志

Objective To study the intestinal bacterial overgrowth(IBO)and bacterial translocation(BT)in cirrhotic rats,and the effect of microecologics on it.Methods In order to induce cirrhosis model the rats were given 40%CCl4 elaeo-solution by subcutaneous injection,then were treated by microecologics(prebiotics and probiotics).The rats were randomly divided into normal control group(13 rats),cirrhosis model group(10 rats),prebiotics therapy group(19 rats),probiotics therapy group(19 rats)and therapy control group(20 rats).To detect endotoxin,cultivate and count enteric bacilli.mesenteric lymph nodes,tissue of liver and spleen were taken to cultivate bacteria.Results ① the counts of small intestinal bacilli in cirrhosis rats were obviously higher than normal rats(P

Clinical features of forty patients with primary biliary cirrhosis / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To study the clinical features of patients with primary biliary cirrhosis (PBC) in order to improve the doctors' awareness of the disease.</p><p><b>METHODS</b>General status, clinical manifestations and laboratory findings of 40 patients with PBC were reviewed.Thirty-seven patients were females (37/40), and the mean age at diagnosis was 50.5 +/- 7.8 years. The time interval from initial symptoms or preliminary diagnosis to final diagnosis was 24.0 +/- 23.6 months.</p><p><b>RESULTS</b>The most frequently reported symptoms were fatigue (67.5%, 27/40), jaundice (60%, 24/40) and pruritus (32.5%, 17/40). Eight patients (20%) had associated auto-immune diseases (Sjogren's syndrome and/or rheumatoid a(c)arthritis). Serum alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (gamma-GT) levels were markedly elevated (520.3 +/- 382.3 IU/L and 648.6 +/- 529.1 IU/L, respectively) in all patients, while alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were mildly elevated (82.6 +/- 54.5 IU/L and 100.7 +/- 47.2 IU/L, respectively). Twenty-four patients (60%) had a total bilirubin level >/= 34.2 micromol/L. Thirty-five patients (87.5%) had elevated serum immunoglobin M,and 97.5% of patients (39/40 ) were anti-mitochondrial antibody (AMA)/AMA-M2 positive.</p><p><b>CONCLUSION</b>Elevated serum ALP and gamma-GT levels, together with a positive AMA/AMA-M2, can help the diagnosis of PBC. Liver biopsy is useful to confirm the diagnosis and to differentiate histopathological stages.</p>