Clinical Analysis On 103 Cases Of Drug-Induced Liver Injury

In the course of the use of drugs,the liver damage that caused by the drug itself and/or its metabolites or the drug hypersensitivity or tolerance reduced called Drug-Induced Liver Injury(DILI),also known as drug-induced liver disease.At present,due to the extensive use of various drugs,DILI has become a common liver disease in China.Therefore,DILI is increasingly affecting the health of mankind.However,DILI has no specific clinical symptoms and biochemical changes,the diagnosis is still difficult,the missed and misdiagnosis rate is still very high.In response to this problem,the Chinese Medical Association Liver Branch published the first guide to DILI in China in 2015,which provides a basis for the diagnosis of DILI.Objective:To analyze the clinical characteristics of drug-induced liver injury(DILI)patients,clear the drug types that can cause DILI,in order to prevent the recurrence of adverse drug events.Methods:A retrospective analysis of the first clinical diagnosis of 1 28 patients with drug—induced liver injury or drug—induced hepatitis or toxic liver disease or toxic hepatitis between January 1,2014 to December 31,2016,re-diagnosis of them according to the diagnostic guidelines for DILI,eliminate the patients that the RUCAM scal less than 6 points,finally 103 cases met the diagnostic criteria.Clinical characteristics of the 103 patients were retrospectively analyzed.including gender,age,career,clinical manifestations,biochemical parameters,medications,DILl type,days of hospitalization,therapy,etc.Results:1.According to the RUCAM scar,the largest percentage in the study is 8 points(25.2%),followed by 7(23.3%),9(22.3%),6(21.4%),10(4.9%),12(1.9%),11(1.0%).2.The incidence of DILI was increasing year by year.3.The average age of onset was 46.75±16.11.Which accounted for the largest proportion of 41-60 years old(44.7%).4.Traditional Chinese medicine(43.7%)was the most common cause,follow by 17 cases(14.3%)of antibiotics,9 cases(7.6%)of anti-tuberculosis drugs,4 cases(3.4%)of weight loss and health care products,Thyroid drugs in 3 cases(2.5%),non-steroidal anti-inflammatory drugs in 3 cases(2.5%),5 cases of gastrointestinal drugs(4.2%).5.Clinical manifestations of nausea,anorexia,tired of oil,abdominal pain,diarrhea and other gastrointestinal symptoms are the most common(43.8%),then skin,sclera yellow and/or urine yellow 45 cases(34.6%),fatigue 12 cases(9.2%),rash,skin itching 2 cases(1.5%),asymptomatic in 14 cases(10.8%).Improved 92 cases(89.3%),ineffective(including automatic discharge and death)in 11 cases(10.7%).6.Clinical classification:According to the course of disease,acute drug-induced liver injury in 94 cases(91.2%),chronic drug-induced liver injury in 9 cases(8.8%);according to the target cell type,90 patients presented with heaptocellular(87.4%),7 patients with cholestatic(6.8%)and 6.patients with mixed(5.8%).The patients presented with heaptocellular injury type had a high level of ALT and AST,and the patients presented with cholestatic injury type had a high level of ALP and GGT.Conclusion:The incidence of drug-induced liver injury gradually increased,has become one of the causes of liver damage.To the elderly more common,often with gastrointestinal symptoms as the first performance.Drugs leading to DILI were:Chinese medicine,antibiotics,anti-TB drugs,diet pills and health products,anti-thyroid drugs,non-steroidal anti-inflammatory drugs.The clinical classification are hepatocellular type,cholestatic type and mixed type,the most common type is hepatocellular.Most of the prognosises are good.