Clinical Analysis Of255Cases With Drug-induced Liver Injury

Backgroud and ObjectiveDrug-induced liver injury (DILI) is caused by the toxic effect of drug itselfand/or their metabolites, or by the allergic reaction to the drug.owadays DILI occursmore and more frequently when more and more drugs are used in the clinical practice.DILI can be seen in patients with or without pre-existing liver diseases. So far, it isfound that about1000kinds of drugs can damage the liver, and damage to the liver isone of the most common causes of the drug delisting. Most foreign experts on thestudy of DILI in the pathogenesis and develop an effective tools of evaluating causalrelationship between drugs and liver damage.Domestic literature carries on thegeneral description and discussion mostly on its etiology, clinical manifestation,diagnosis, treatmen and so on,but the statistical analysis of the prognosis and itsinfluencing factors is less.The purpose of this study is to retrospectively analyze the clinical characteristicsof DILI. In addition to also statistical analysis of DILI,compare the most commonlyused abroad two causality assessment tool (RUCAM, Maria scoring system)discrimination, discuss which scoring system is more suitable for our country inclinical practice.MethodsThe clinical data of two hundred and fifty five DILI cases diagnosed in ourhospital from2006to2012were collected, including gender,age,symptoms,onsettime, suspected drugs,liver function changes, blood coagulation changes,hepatitisvirus markers,liver images, treatment, prognosis and its influencing factors. we scored the cases by RUCAM Scoring system and Maria Scoring system, to assess thecausal relationship between drugs and liver damage,to compare their discrimination,todiscuss their applicability in our country.ResultsDILI hospitalized cases increased year by year.Of the255patients, there were122males and133females and the average age was52.16±18.49. Start to appear theclinical symptoms within12weeks (228cases,89.4%) after using the drugs.Thesymptoms are no specific, including weak, anorexia, Jaundice, yellow urine,etc,and44.3%of patients are asymptomatic. The most common cause of liver damage drugsare Chinese herbal medicine and Chinese patent medicine (20.8%), lipid-loweringdrugs (11.8%), antitumor drugs (11.8%), anti-tuberculosis drugs (11.4%), antihyperthyroidism drugs (8.2%), NSAIDs (8.2%), and other system of medicine, suchas clindamycin, fluconazole,allopurinol,etc.)also are involved.Most of the DILI cases(87.6%) were categorized as hepatocyte type, while6.9%and5.1%were categorizedas cholestasis type and hybrid type, respectively.In DILI prognosis, cured139cases(71.6%), improvement in34cases (18.0%),18cases (9.3%) were not cured,3casesdied (1.5%). DILI prognosis mainly has something to do with patient’s age, clinicalclassification, with basic liver diseases, while has no connection with patient’s gender,the types of drugs. The older, the worse prognosis.The patients with liver cell damagetype or merge the liver disease are poor prognosis.In the results of assessing causalrelationship between drugs and liver damage, we konw that RUCAM scoring systemshow23.8%of cases suggest suspected drug "very likely" causes liver damage,62.5%"likely",11.3%"may".Instead in Maria scoring system, almost all cases are in"possible"(42.1%) and "unlikely"(55.4%). By contrast, RUCAM is morediscriminating than Maria scoring system, is more suitable for our country in clinicalpractice.ConclusionFemale incidence was slightly higher than male. DILI occurs in after age40.TheClinical symptoms vary,and there are not a few patients with clinical symptoms. DILIcaused by drugs in different clinical departments.In this investigation,Chinese herbalmedicine and Chinese patent medicine accounted for most. Most of his prognosis is good. The older, the worse prognosis.The patients with liver cell damage type ormerge the liver disease are poor prognosis. On the contrary,the prognosis has noconnection with patient’s gender, the types of drugs.RUCAM scoring systemdetermines whether the drug induced liver injury has a better clinical guidingsignificance, more suitable for the actual clinical application in our country. But westill need as soon as possible to develop a more perfect, more accurate diagnosticcriteria.