The Research Of The Clinic Features And Diagnosis Of Drug-induced Liver Disease

Background and purposeRecent ly, with the development of the usage of the drug, the prevalence of drug-induced liver disease(DILD) is increasing too. Drugs have become the second cause of liver injury just next below the athogenic microorganisms. In the United States, drugs are estimated to accout for approximately 10-20% of cases of asce nding transamination enzyme and more than 50% of cases of acute liver failure. In our country, drugs and alcohol is the second cause of liver failure. In those combination or biological pharmaceuticals on market, there are more than 1100 kinds of drugs have potential hepatotic toxicity, and it is also for lots of excipient, herbal medicine and health care medicine.DILD can characterize by any kind of acute or chronic liver disease, and acute liver injury is the most common case .Most clinic features ofDILD are not distinctive ,and there are no specific markers or tests for DILD.The diagnosis of DILD requires a high level of suspicion therefore ,it is often easily misdiagnosed or overlooked in clinical practice. Recently, the researchers from home and abroad have already constantly amended the standard of diagnose. The common methods for assessing DILD include the Criteria of DILD developed in 1990's Paris international consensus meeting ,the Roussel Uclaf Causality Assessment Criterion modified in 1993 by Danan, and the Clinical Diagnostic Scale developed and validated by Maria in 1997.To study the etiology and clinical features of DILD to improve the clinician's understanding on it, to analysis the congruity and its advantages or disadvantages between Danan's and Maria's scale ,to modify and perfect the diagnose of the DILD,we conducted the research of the clinic features and diagnosis of DILD. Materials and methods332 cases of drug-induced liver disease admitted to the First Affiliated Hospital of Zhejiang University from 2000 to 2006 according with the criteria of DILD devolped in 1990's Paris international consensus meeting were recruited.The elements presented include a brief clinical history, detailed pharmacological data,the results of laboratory tests, and all the relevant investigation performed including ultrasonography of the liver and biliaryand tract, clinic manifestation, outcome and prognosis .Each case was assessed with both the Danan' and Maria' scales by the same investigator to ensure uniformity of the data and compliance with each system's requirements.Satistical analysis: Data were analyzed using SPSS15.0 software.Multiple comparison were performed using x~2 test , Spearman relative analsis and Logistic analysis.Results1.A variety of drugs, including herbal medicines (27.11% of our totalcases), anti-tuberculosis drugs (13.25%) and immunosuppressivedrugs(10.84%) caused drug-induced liver damage.2. The hepatocellular type was common in clinic manifestation(43.07%), themixed type and cholestaticis type was relatively less than it.3.Comparing with the two clinical diagnose scales by Spearman correlationanalysis,it showed that they had positive correlation .The Danan's scaleshowed better discriminative power and produced assessments closer toclinical determinant.4.Among all the cases, 50.79% cases were cured , 26.60% were relieved,while 7.53% cases were gotten worse and then leave hospital or died.Univariate Logistic analysis showed that age, TP, ALB, CHE, TBA, TBIL,DBIL, GGT, PT was affected factors on prognosis. For deeply analysis onthese factors by Multivariate Logistic analysis, it showed ALB, TBA, DBIL, PT was independence affected factors, the value of OR was 0.811, 1.012, 1.010,1.242. From the OR value, it was found that the lower ALB value the worse prognosis, while TBL, DBIL, PT was just the opposite. The model tested by Hosmer-lemeshow method showed it was fitted good(x~2=0.243, P=1. 000).Conclusion1.There are various of medicine dued to DILD, while herbal medicines,anti-tuberculosis drugs and immunosuppressive drugs was predominated.2.The hepatocellular type was common, the mixed type was less and whilethe cholestaticis type was the least one.3.Comparing with the two clinical diagnose scales by Spearman correlationanalysis,it showed that they had positive correlation .The Danan's scaleshowed better discriminative power and produced assessments closer toclinical determinant.4.ALB, TBA, DBIL, PT are the most important predictors of the prognosisof DILD.