Retrospective Analysis On Clinical Features,TCM Constitutions And TCM Syndromes Of Drug-induced Liver Injury

Objective:To retrospectively analyze the clinical characteristics,TCM constitution and syndrome types of patients with drug-induced liver injury(DILI),analyze the distribution of TCM constitutions and syndromes,and explore the correlation with the onset of drug-induced liver injury,Provide reference basis for clinical medical staff to carry out the clinical diagnosis,prevention and control and treatment of DILI.Methods:In this study,the case and order system of affiliated hospital of Nanjing University of Traditional Chinese Medicine(Suzhou Traditional Chinese Medicine Hospital)was used to select patients who were hospitalized and discharged from January 2016 to December 2020 The first page of their medical records was retrieved and the discharge diagnosis was Case data of "drug-induced hepatitis","drug-induced liver damage","toxic hepatitis" and "toxic liver disease",and further screened the subjects that met the inclusion criteria.A total of 214 cases were studied.Retrospectively analyze the actual clinical gender,age,past history,suspicious drugs,clinical manifestations,examination results,Western medicine classification,severity of liver injury,TCM syndromes,TCM constitutions,RUCAM score,prognosis,hospital days,etc.Statistical analysis was performed using SPSS26.0 softwareResults:1.Among the 214 patients,89 were males(41.59%)and 125 were females(58.41).The male to female ratio was 1:1.4.The age range is 17-87 years old,with an average age of 51.83±16.73 years old.Among them,the most patients are between 41-60 years old,with 85 cases(39.72%).Among DILI patients,202(94.4%)had underlying diseases,and the top three were:digestive system diseases(116,54.2%),cardiovascular diseases(66,30.8%),endocrine system diseases(47,22.0%).Among the DILI cases,there were 120 cases(56.07%)caused by western medicine alone,28 cases(13.08%)caused by Chinese patent medicine,22 cases(10.28%)caused by Chinese herbal medicine,35 cases(16.36%)caused by mixed use of Chinese and Western medicine,and there were 9 cases(4.21%)caused by taking healthcare products.2.The clinical manifestations of patients are mainly fatigue(48.60%),anorexia(39.72%),jaundice(34.11%),etc.The specific clinical classification was 144 cases(67.29%)of hepatocellular injury,21 cases(9.81%)of cholestasis,and 49 cases(22.90%)of mixed type.The TCM syndromes in descending order were 85 cases of damp-heat stagnation syndrome(39.72%),50 cases of liver depression and spleen deficiency syndrome(23.36%),44 cases of liver and kidney yin deficiency syndrome(20.56%),and 18 cases of qi stagnation and blood stasis syndrome(8.41%),17 cases(7.94%)of cold and dampness syndrome.The most TCM constitution is qi-deficiency(47 cases,21.96%)3.There are significant differences in the clinical classification of patients in age,PA,ALB,AST,TBIL,DBIL,and IBIL.There are obvious differences in the types of drugs,severity of liver damage and outcomes,PA,ALT,AST,GGsT,TBIL,DBIL,and IBIL among the various TCM syndromes.There are significant differences in age,ALB,ALT,TBIL,DBIL,and IBIL among the various TCM constitutions types.4.Logistic regression analysis indicated that having gallbladder organic disease are risk factors for severe liver injury(P<0.05).High INR and ALP,and the TCM syndromes as qi stagnation and blood stasis syndrome,liver and kidney yin deficiency syndrome,and biased constitution are the risk factors for poor prognosis(P<0.05).Conclusion:1.Among the 214 study subjects,most are women and elderly patients.2.The categories of drugs that are likely to cause DILI are Western medicine,Chinese patent medicine,Chinese medicine decoction pieces,and healthcare products in order from most to least.3.The most common type of DILI is hepatocellular damage.The most common TCM syndromes are qi stagnation and blood stasis syndrome,liver and kidney yin deficiency syndrome.The TCM constitutions are most common in qi-deficiency.4.Having gallbladder organic disease are risk factors for severe liver injury.High INR and ALP,TCM syndromes as qi stagnation and blood stasis syndrome,liver and kidney yin deficiency,and biased constitution are risk factors for poor prognosis.