Clinical Analysis Of 108 Cases Of Drug Induced Hepatitis

Drug induced liver injury is a common liver disease that affect the health ofmankind severely. The incidence of drug induced hepatitis increased graduallythese years with the use of so many new drugs. To enhance the understanding ofdrug induced hepatitis, we analyzed the epidemiology, etiology, and clinicalpresentations of 108 drug induced hepatitis patients in this study.Methods: The retrospective analysis was performed in this study to 108patients that diagnosed drug induced hepatitis in Gastroen-terology departmentof our hospital From 1995 to 2004.The observing contents include:1.Epidemiology: sex, the relation of age and incidence rate. 2. Etiology: thecategory of drugs that induced hepatitis and the combined factors of liverdamage.3. Clinical presentations: the occurring time of liver damage of all kindsof drugs; symptoms and physical findings. 4. Laboratory data: the feature inserum of drug induced hepatitis such as routine examination, and AST ALT BIL,and so on. 5. The use of drugs that have liver damage was ceased immediatelyand comprehensively conservative therapy was needed when the diagnosis ofdrug induced hepatitis was established.Results: 1.The incidence rate of male to female was 1:1.51.The on-set peakhappened in the 40—49 year-old in 108 cases of drug induced hepatitis in thisstudy.2. The category of drugs that induced hepatitis: The most common drugsthat induced liver damage are herbal medicine and anti-tuberculosis drugs.There are 18(16.67%)cases with alcoholic history .3. Most of the liver damageinduced by drugs appeared during half month to a month. 4. Clinicalpresentations: No specific clinical presentation of drug induced hepatitis wasfound in this study. The peptic symptoms were inertia, anorexia, satiety, andnausea.5. Laboratory examination: The laboratory data of drug induced hepatitiswere vague and unspecific. Blood examination: Elevated leukocyte count wasfound in 90 cases(83.33%)Liver function: ALT elevated obviously than AST.There were 62 cases with jaundice, especially with obstruct jaundice.6.Misdiagnosis: Misdiagnosis was not rare because the drug induced hepatitisoften combined with other diseases and the clinical presentations or laboratorydata were unspecific.8 cases were misdiagnosed in this study and 5 cases(62.50%) misdiagnosed to virus hepatitis.7. Treatment and prognosis: The use ofdrugs that have liver damage was ceased immediately and comprehensivelyconservative therapy was needed when the diagnosis of drug induced hepatitiswas established. 13 cases were cured, 94 cases were mended, and 1 case died inthis study.Discussion: 1. There were total 108 cases that diagnosed drug inducedhepatitis from 1996-2004 in our department. The ratio of drug induced hepatitispatients in our hospital increased gradually, similar to the statistic data fromother hospital in China.2. The incidence rate of male to female was 1:1.51.Theincidence of female was higher than male. It maybe correlates with diseases thatoften happened in female such as biliary cirrhosis.3. There was no significantdifference in age. The on-set peak happened in the 40—49 year-old in 108 casesof drug induced hepatitis in this study. It is different with previous data.Insufficient samples maybe explain the difference. The category of drugs thatinduced hepatitis: The most common drugs that induced liver damage are herbalmedicine and anti-tuberculosis drugs in this study. The result showed that manyliver injury induced drugs are herbal medicine. It is not correspond with theprevious studies. Anti-tuberculosis drugs are the most common drugs thatinduced hepatitis in the previous studies in China. They demonstrated that theincidence of drug induced hepatitis was 17.2%—25.0% by use INH,RFP,PZAin tuberculosis therapy. 5.Combined liver damage factors: There are 18(16.67%)cases with alcoholic history in this study. Previous studies in Chinademonstrated that the liver damage in patients with liver disease history wasmore severe than patients without liver disease history, and the mortality washigher also. The died case in this study was infected hepatitis virus. Time ofdrug induced liver damage: The minimum time was 3d after treatment, and themaximum was two years. Most of the liver damage induced by drugs appearedduring half month to a month. It is similar to the previous studies. Clinicalpresentations: No specific clinical presentation of drug induced hepatitis wasfound in this study. The peptic symptoms were inertia, anorexia, satiety, andnausea. The other features such as skin pruritus and fever also can be seen.Physical findings: skin and sclera jaundice in 60 patients, hepatomegaly in 27patients, macule in 2 cases, splenomegaly in 6 cases, ascites in 2 cases.Theclinical presentations of drug induced hepatitis was similar to virus hepatitis andoften neglected by physicians. Physicians should avoid using drugs withhepatotoxicity. Studies showed that 2-5% patients in abroad hospital withjaundice was drug induced hepatitis and 20-50% fulminant hepatic failure wasrelated with drugs.8. Laboratory examination: The laboratory data of druginduced hepatitis were vague and unspecific . Blood examination: Elevatedleukocyte count was found in 90 cases(83.33%)Liver function: AST elevatedobviously than ALT. There were 62 cases with jaundice, especially with obstructjaundice. 9. Misdiagnosis: Misdiagnosis was not rare because the drug inducedhepatitis often combined with other diseases and the clinical presentations orlaboratory data were unspecific.8 cases were misdiagnosed in this study and 5cases (62.50%) misdiagnosed to virus hepatitis. Thus the prescription ofphysicians should be in reason. Physicians should take the drug inducedhepatitis into account, cooperating with drug treatment history and diagnosistests, to diagnose drug induced hepatitis in early stage. 10. Treatment andprognosis: The use of drugs that induced liver damage was ceased immediately.The patients relaxed in bed, enough quantity of heat, protein, and vitamin wereadministered intravenously, liver function was intensive monitored. During thetreatment of drug induced hepatitis, we should not neglect the therapy oforiginal diseases. For example, 6 patients were hyperthyroidism in this study.Anti-thyroid drugs with liver damage should be replaced in time. Moreparticular diagnosis were not classified .Most of 108 drug induced hepatitis inthis study alleviated with comprehensively therapy in 2～3rd weeks, ALTdecreased significantly.13 cases were cured in 13th weeks. The symptom andphysical findings of 94 cases were mended significantly; liver functions wereclosed to normal. 1 case died by fulminant hepatic failure in this study.12.Prevention measure is the key to avoid drug induced hepatitis. Common historyaspect, drug hypersusceptibility and toxicosis history should be ascertainedwhen liver damage drugs be used. The use of hepatotoxic drugs to patients withoriginal liver disease should be careful. If the usage of hepatotoxic drugs isneeded, the dose should be controlled and liver function should becomprehended. Liver function should be monitored with long-term usage ofhepatotoxic drugs.In conclusion, drug induced liver injury is a common liver disease that...