Analysis On The Clinical Characteristics Of Drug-induced Liver Injury In Patients With Chronic Hepatitis B Virus Infection

Objective: To investigate the clinical characteristics of drug-induced liver injury(DILI) in patients with chronic hepatitis B virus(HBV) infection.Materials and Methods: We selected patients with DILI by our hospital’s records system from January 2013 to December 2015 period.(HBV+DILI) group: 93 cases of DILI with chronic HBV infection were included in our study as(HBV+DILI) group from January 2013 to December 2015 period.DILI group: 102 cases of DILI without chronic HBV infection were included in our study as DILI group from January 2013 to December 2015 period.Record sex, age, therapy duration, allergic history, hepatotoxic drug, clinical symptom, liver function, therapy effect and other related information.Results:(1) In(HBV+DILI) group, the ages of onset were from 18 to 75 years, the median age was 42 years. Of these 93 patients in(HBV+DILI) group, 62(66.67%) were male and 31(33.33%) were female, with the ratio of 2:1.In DILI group, the ages of onset were from 18 to 72 years, the median age was 50 years. Of these 102 patients in DILI group, 31(30.29%) were male and 71(69.61%) were female, with the ratio of 1:2.3.There is statistical significance in the ages of onset between two groups(Z = 2.897, P = 0.004). The ages of onset in(HBV+DILI) group is less than that in DILI group and males are significantly more than DILI group.(2)The most common hepatotoxic drugs in(HBV+DILI) group is herbal medicine(59.14%), followed by antibacterials(8.60%) and anti-inflammatory drugs(5.38%). Compared with DILI group, there is no statistical significance.(3)There is no specificity in the clinical symptoms of liver injury in two groups. Jaundice, fatigue, nausea, vomiting, loss of appetite, flatulence and liver discomfort are the main symptoms. There are 10(10.75%) cases that have allergic histories in(HBV+DILI) group and 15(14.71%) cases in DILI group. There was no significant difference in the proportion of patients with a history of allergies in two groups.(4)In(HBV+DILI) group, it included 82(88.17%) hepatocellular injury, 10(10.75%) mixed injury, and 1(1.08%) cholestatic injury cases. In DILI group, it included 86(84.31%) hepatocellular injury, 9(8.82%) cholestatic injury, and 7(6.86%) mixed injury caces. There is significant difference in the clinical patterns of liver injury at the onset compared with the DILI group. Hepatocellular injury is both common in two groups, but cholestatic injuries in(HBV+DILI) group are more than in DILI group.(5)The severity of liver injury in(HBV+DILI) group are mild(38cases,40.86%), moderate(13cases,13.98%),severe(17cases,18.28%),liver failure(21cases, 22.58%) and fatal(4cases,4.30%).The severity of liver injury in DILI group are mild(52cases,50.98%), moderate(13cases,12.75%), severe(33cases,32.35%), liver failure(2cases, 1.96%) and fatal(2cases,1.96%).There is significant difference in the severity of liver injury between the two groups. Although both are given priority to mild, but patients with liver failure and fatal liver failure in(HBV+DILI) group are significantly more than the DILI group. The severity of liver injury in(HBV+DILI) group is heavier than the DILI group. The levels of bilirubin were compared in two groups of patients with the same liver injury severity. The mean value of bilirubin in(HBV+DILI) group is that(117.49 + 20.61) umol/L in moderate cases,(290.02 + 104.49) umol/L in severe cases, and(480.36 + 137.16) umol/Lin liver failure cases. In DILI group, the mean value of bilirubin level is that(107.23 + 14.39) umol/L in moderate cases,(349.72+147.77) umol/L in severe cases, and(492.50 + 119.50) umol/L in liver failure cases. There is no difference in the mean value of bilirubin level between the two groups.(6) The longest hospital duration in(HBV+DILI) group is 75 days and the median duration is 11 days. In DILI group, the longest hospital duration is 50 days and the median duration is 9.5 days. There is no significant difference in two groups. 79(85.87%) cases of patients were cured in(HBV+DILI) group and 13(14.13%) cases died or had no improvement. In the DILI group, 99(97.06%) cases were survived and 3(2.94%) cases died. The prognosis of the(HBV+DILI) group is significantly worse than the DILI group. In high viral load group(HBV DNA≥106 IU/ml), 37 cases(84.09%) were cured or improved and 7cases died or had no improvement. In low viral load group, 42(87.50%) cases were cured or improved and 6(12.50%) cases died or had no improvement. There is no significance in two groups. So the level of HBV DNA in(HBV+DILI) group has little effect on the prognosis.Results:The clinical characteristics of drug-induced liver injury in patients with chronic hepatitis B virus infection are as following:1. The ages of onset are lower than in DILI group and males are more than females.2. The most common hepatotoxic drugs is herbal medicine, followed by antibacterials and anti-inflammatory drugs. There is no statistical significance between two groups.3. There is no specificity in the clinical symptoms between the two groups and no significant difference in the proportion of patients with allergies.4. The clinical patterns of liver injury with chronic HBV infection at the onset were followed by hepatocellular injury, mixed injury and cholestatic injury.5. The severity of liver injury is heavier than that in DILI group.6. The prognosis of patients is significantly worse than that in DILI group.7. The level of HBV DNA in(HBV+DILI) group has little effect on the severity and prognosis.