Cases From The Database Of Chinese Herbal Medicine Clinical And Pathological Study On Liver Injury

Objective:Collected the hospital clinical data being cleared diagnosis of liver injury caused by Chinese herbal medicine.Analyse the clinical and biochemical characteristics of different types of herbs causing liver injury, And analyze the histopathological features of liver injury Provide more accurate herbal liver injury data. To provide more evidence for the diagnosis and prevention of Chinese herbal medicine induced liver injury.Methods:1. Seventy-four patients with suspected Chinese herbal medicine-induced liver injury were admitted to our hospital and maked liver biopsy between2009and2011. Recorded underlying diseases, medication (including medication varieties, medication time, medication dose, frequency of medication, withdrawal time), clinical symptoms (including the onset of symptoms, systemic symptoms, the local symptoms), laboratory parameters (including liver function, bloodpractices, their own antibodies, special proteins, HAV.HBV, HCV.HDV, HEV, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, rubella virus serum markers), organizations biopsy data. And use R value (R=The ratio of alanine aminotransferase (ALT) and its upper limit of normal (ULN)/the ratio of alkaline phosphatase (ALP) and its ULN2. Analyse the clinical and biochemical characteristics of Chinese herbal medicine-induced liver injury by chi-square test.Results:①ata of patients with liver injury caused by Chinese herbal medicine is74cases,73%(54/74) of them are female, Patients over the age of55is28.4%(21/74).②The most common clinical symptoms are fatigue (52/74)70.2%. More than half of patients with gastrointestinal symptoms,59.4%(44/74). Other symptoms included fever (14/74)18.9%, rash (4/74)5.4%. joint pain (3/74)4.1%. Clinical types:hepatocellular (58/74)78.4%, cholestasis (7/74)9.5%, mixed (3/74)4.1%, and unclassified (6/74)8.1%.③Chinese herbs suspiciously cause liver injury include polygonum multiflorum thunb, dicttamnus dasycarpusDioscorea bulbifera L,cnidiummonnieri L,myrrh,rhubarb,panax notoginseng powder,realgar.radix sophorae tonkinensis,psoralea fruit,trichosanthin,rhizoma orydalis;Chinese patent medicine including yishen wufa oral liquids,yangxueshengfa capsules,lingyangqingfei pill,rupisanjie capsule,gukang capsule,xianling gubao capsule.bushenyangnao pill,gujinwan capsule,fengtongdin capsule.jiuqiniantong pill,keyin pill,compound qingdai wan.jinggangteng capsule.④Chinese herbal medicine liver injury liver function is usually the performance of alanine aminotransferase were significantly increased (ALT≥5×UNL), Total bilirubin was significantly elevated (TBIL≥2×UNL), The increase in eosinophils (>6%) is rare, accounting16.2%. The ALT and AST decreased significantly within one week after patients stop taking their medication, but serum bilirubin level is relatively backward in ALT and AST.⑤70cases of liver pathology manifestations are acute liver injury.3cases manifested as chronic liver injury,1case has no significant liver injury.A big variation in acute liver injury,The hepatocellular signs turn into feathery swelling,eosinophilic degeneration and apoptotic bodies,confluent necrosis around the central vein and hepatic lobule spotty necrosis.the types of appearance of inflammatory cells around the central vein(n=67),including the infiltration of neutrophil and eosinophil.rare plasma cells;inflammation in portal area is relatively light,eosinophil infiltration is relatively less than that around the central vein.27patients had evidence of confluent necrosis in hepatic lobule3,4patients exist bridging necrosis.Active kupffer cells sign in hepatic sinusoidal around necrosis(n=56),hepatocellular cholestasis (n=30),bile capillaries cholestasis(n=23),small bile ducts cholestasis(n=2).Conclusions:Chinese herbal medicine-induced liver injury often occurred in female and in older age groups,and was increasing trend.maybe associated with an increase using frequency of herbs during the older age groups.The liver function recovered rapidly while timely detection and after drug withdrawal,and good prognosis generally,no apparent seqelae.The type of liver injury is mainly hepatocellular,vast majorty was onset.The sign of histopathology prompted acute liver injury.Typical visible inflammation and confluent necrosis around the central vein,active kupffer cells around the area of inflammation and necrosis.The portal area was no significant expansion.The liver injury type of cholestasis and mixed model expressed cholestasis in liver cells and bile canaliculies. but not in bold duct.So,histopathology proviceded an important reference for the clinical differential diagnosis and prognosis.