| BACKGROUNDS AND AIMS:With the increasing morbidity of drug-induced liver injury(DILI),it has attracted widespread attention among clinicians and academics in the past decade.However,due to its diverse clinical manifestations and the lack of specific laboratory diagnostic indicators,timely diagnosis of DILI is still a major challenge in clinical work.The study retrospectively analyzed the clinical data and prognosis of 265 DILI patients admitted to the First Hospital of Lanzhou University in the past10 years,in order to provide reference for clinicians in the diagnosis,treatment and prevention of DILI.METHODS:684 cases of hospitalized patients with DILI diagnosed in the First Hospital of Lanzhou University from June 2008 to September 2018 were screened,and 265 cases were included in the study.Univariate analysis was performed on the general conditions,clinical features,and related ind-icators of the different treatment outcome groups.Finally,the binary logistic regression analysis was used to evaluate factors that may affect prognosis.RESULTS:1.In the past 10 years,the largest number of hospitalized patients was in 2016,accounting for 16.23%.The average number of hospitalizations per year from 2010 to 2018 was more than t-hat between 2008 and 2010.Female patients accounted for 58.87%(P=0.005);there were signific-ant differences in hospitalizations among all age groups(p=0.000),mainly concentrated in 35-64 years old,accounting for 68.30%.Among the underlying diseases that cause DILI medication,the top three were: respiratory diseases(24.2%),digestive diseases(12.8%),and skin diseases(12.1%).Among the different types of drugs that led to DILI,Chinese medicine ranked first(48.68%),followed by anti-tuberculosis drugs(21.89%),and anti-microbial and antipyretic analgesics(7.55%).2.252(95.09%)patients with acute onset,Most patients with onset of medication for 5-30 da-ys,The clinical manifestations of DILI lack specificity,and the most common symptoms are fati-gue and anorexia.Twenty-two patients had a history of DILI,Six cases have progressed to cirrhosis with a history of long-term,chronic discontinuous medication.Grade 2 moderate liver injury and grade 3 severe liver injury accounted for 72.83%(P=0.000);hepatocyte injury type accounted for 64.15%(P=0.000),cholestasis type accounted for 18.87%,and mixed type accounted for 8.68%.ALT is the most significant indicator of liver function,with an average of 480.00(188.00-849.50)U/L and >8ULN accounting for 56.23%.Patients with ALT exceeding 8 ULN accounted for56.23%.The pathological changes of 15 patients with liver biopsy were mainly acute hepatitis.A mong the DILI caused by different drugs,female patients were more common(P=0.005),and tho-se aged 40-60 years were more common;the INR abnormalities of anti-tuberculosis-related DILI were the most obvious(P=0.001).3.The prognosis of 237 patients(89.43%)was favourable,90 cases(33.96%)were cured,147 cases(55.47%)were improved;28 patients(10.57%)had a poor prognosis,22 cases(8.30%)w-ere ineffective,and 6 cases(2.27%)died.Grade 2 moderate liver injury and grade 3 severe liver injury accounted for the majority in the group with a good prognosis(P<0.05).In the poor prog-nosis group,the majority of patients were acute liver failure.Patients with poor prognosis often had multiple complications(P = 0.000),and those with a single complication had a good prognos-is(P = 0.000).TBIL,DBIL,TBA,INR,and AFP were more significantly increased in the poor prognosis group(P<0.05).The binary logistic regression analysis showed age(65-79 years old)(OR=10.222,P=0.044),previous DILI history(OR=15.772,P=0.010),multiple complications(OR=0.004,P=0.000),TBIL(OR=0.993,P=0.047)may be independent risk factors for prognosis.CONCLUSIONS:1.In the past 10 years,the number of hospitalized patients with DILI in the First Hospital of Lanzhou University has increased,it was more common in people aged 35-64 and in female p-atients.The top three diseases causing medication treatment were: respiratory diseases,digestive diseases,skin diseases.Traditional Chinese medicine was the most common type of medication,mainly for the treatment of skin diseases and musculoskeletal diseases,followed were anti-tubercul-osis drugs,anti-microbial drugs and antipyretic analgesics.2.DILI acute onset was more common,the mainly injury type and severity of injury were l-iver cell injury type,moderate grade moderate liver injury and grade 3 severe liver injury.ALT was the most significant liver function index,INR was most abnormal in anti-tuberculosis drug-re lated DILI.3.The majority of DILI patients had a good prognosis.Old age,recurrent DILI,multiple co-mplications,and TBIL may be independent risk factors for prognosis.TBIL,DBIL,TBA,INR,a-nd AFP were more prominent in the poor prognosis group. |
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