地高辛中毒临床表现不存在与年龄相关的差异。

Lack of age-related differences in the clinical presentation of digoxin toxicity.

作者信息

Wofford J L, Hickey A R, Ettinger W H, Furberg C D

机构信息

Department of Internal Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.

出版信息

Arch Intern Med. 1992 Nov;152(11):2261-4.

PMID:1444686

Abstract

BACKGROUND

Digoxin toxicity occurs most commonly among the elderly. While the clinical syndrome of digoxin toxicity is well understood, how toxic manifestations change with age is not known.

METHODS

We performed secondary analysis of data from a postmarketing surveillance study of patients with life-threatening digoxin toxicity treated with digoxin antibody therapy. Patients receiving long-term maintenance digoxin therapy and aged 55 years or older were divided into four age groups: 55 to 64, 65 to 74, 75 to 84, and 85 years and older (n = 45, 167, 183, and 83, respectively) and compared with regard to presenting manifestations, digoxin dosing, serum potassium and digoxin levels, and renal function.

RESULTS

The prevalence of high-degree atrioventricular block showed an increasing but nonsignificant trend with age (40%, 40%, 42%, and 47%, respectively). Age-related trends in high-degree atrioventricular block were stronger among men than women and even stronger among men with underlying cardiac ischemia. The proportion of subjects with nausea/vomiting as a toxic manifestation did not consistently change with age (42%, 48%, 48%, and 46%, respectively). There were no age-related differences in degree of renal impairment or maintenance dose, but maintenance dose decreased with increasing renal impairment.

CONCLUSIONS

Among patients with life-threatening digoxin toxicity, there is no age-related difference in clinical presentation.

摘要

背景

地高辛中毒最常见于老年人。虽然地高辛中毒的临床综合征已为人熟知，但中毒表现如何随年龄变化尚不清楚。

方法

我们对一项关于接受地高辛抗体治疗的危及生命的地高辛中毒患者的上市后监测研究数据进行了二次分析。接受长期维持地高辛治疗且年龄在55岁及以上的患者被分为四个年龄组：55至64岁、65至74岁、75至84岁以及85岁及以上（分别为45例、167例、183例和83例），并就其临床表现、地高辛剂量、血清钾和地高辛水平以及肾功能进行了比较。

结果

高度房室传导阻滞的患病率随年龄呈上升趋势，但无统计学意义（分别为40%、40%、42%和47%）。高度房室传导阻滞的年龄相关趋势在男性中比女性更强，在有潜在心脏缺血的男性中更强。以恶心/呕吐作为中毒表现的受试者比例并未随年龄持续变化（分别为42%、48%、48%和46%）。肾功能损害程度或维持剂量方面无年龄相关差异，但维持剂量随肾功能损害加重而降低。