Clinical Characteristics Of Drug-induced Liver Injury And Treatment Of Drug-induced Liver Injury With Severe Hyperbilirubinemia

Objective: The study retrospectively analyzed the clinical data of patients diagnosed with drug-induced liver injury(DILI)in the Department of Gastroenterology,the First Affiliated Hospital of China Medical University from 2017 to 2021.The purpose of this study is to explore the pathogenic drugs,patient characteristics,serology,treatment and prognosis of DILI,and to analyze the treatment of DILI patients with severe hyperbilirubinemia,so as to increase the clinician’s understanding of DILI and provide basis for the diagnosis and treatment of DILI in the future.Methods: A total of 472 hospitalized patients diagnosed with DILI in the Department of Gastroenterology,the First Affiliated Hospital of China Medical University from January2017 to December 2021 were collected,and 374 patients who met the diagnostic criteria were selected for research.The basic information and treatment process of patients were collected and analyzed.Results: 1.Among 374 DILI patients,the median age was 55.00(46.00,62.30)years,and the peak age was 48-67 years.The male to female ratio was 1:2.56.The drugs causing DILI were mainly traditional Chinese medicine(60.96%),followed by western medicine(19.25%).Single agents of western medicine accounted for 88.89%,mainly including antipyretic and analgesic drugs(19.44%),antineoplastics and immunomodulators(26.39%),anti-infectious drugs(12.50%).The clinical manifestations of DILI are varied,and the common symptoms include dark urine color(70.58%),yellow skin sclera stain(68.45%),loss of appetite(58.29%),fatigue(53.48%).The main clinical type was hepatocyte injury type(59.10%),followed by cholestasis type(23.80%)and mixed type(17.10%).The main severity was Grade 3(51.08%).2.148 DILI patients(39.57%)with severe bilirubinemia in the study.69 patients with the same baseline were selected to analyze.They were divided into artificial liver support system group(observation group,26 cases)and conventional medical group(control group,43 cases)according to the different treatment.After the end of treatment,ALB and GGT in observation group was significantly higher than that in control group(P < 0.05).The total reduction rate of TBIL and DBIL in the observation group was significantly higher than that in the control group(P < 0.05).The mean treatment time of the observation group was 19.08±5.78 days,and of the control group was 22.00±5.84 days.There was significant difference(P < 0.05).The average treatment time for TBIL reduction rate of30% and 70% in the observation group was significantly shorter than that in the control group(P < 0.05),while for TBIL reduction rate of 50% had no significant difference.The effective rate was 92.31% in the observation group and 86.05% in the control group,with no statistical difference(P > 0.05).3.93.85% of DILI patients had a good prognosis(cured or improved),and 6.15% of DILI patients had a poor prognosis.The results of multi-factor Logistics regression analysis showed that ALP(OR= 1.003,95%CI1.001-1.005,P= 0.010)、 ALB(OR= 0.861,95%CI 0.770-0.963,P= 0.009)were independent risk factors of prognosis.Conclusion: DILI mainly occurs in middle-aged and elderly women,with various clinical symptoms.The suspected drugs causing DILI are mainly traditional Chinese medicine.artificial liver support system is effective in treating DILI patients with severe hyperbilirubinemia,which can rapidly reduce bilirubin and shorten the course of the disease.The prognosis of DILI is mostly good,and ALP and ALB are independent risk factors affecting the prognosis.