Diagnostic Differences And Clinical Characteristics Of Chinese Herbal Medicine-related Liver Injury In Chinese And Western Hospitals

Objective: To compare whether there is a difference in diagnosis of patients with HILI in Chinese and western hospital,to explore the clinical characteristics of Chinese herbal medicine related to liver damage,so as to deepen the understanding of Chinese herbal medicine correlation of liver damage,improve the level of the diagnosis of this disease.Methods: Through case retrospective study method,search three hospital electronic medical record system or manual refer to print records,record three hospitals,s clinical data of patients with hepatic injury may be correlated with Chinese herbal medicine according to the information collection table.Apply RUCAM causal score(more zhan3 points)to causality score of cases,and diagnosis for each people with liver damage related to Chinese herbal medicine according to Chinese herbal medicine guidelines.Then analysis whether there is a difference in diagnosis of patients with HILI in hospital of different clinical background.Lists medication history,clinical manifestation,laboratory indexes and prognostic outcomes of all cases of Chinese herbal medicine correlation liver damage,using SPSS17.0 statistical finally.Results: this study collected 349 DILI cases in three hospitals,180 cases of them may be associated with Chinese medicine,2 cases cannot be evaluated because of missing data,13 cases of them has not been achieved the biochemical criteria of liver injury,so a total of 165 cases can be evaluated applying with RUCAM scale causality assessment,fanily there are totally 93 cases,s grades are more than 3.Diagnosis for 93 cases suspected HILI according to Chinese herbal medicine guidelines,final diagnosis are 2 cases,clinical diagnosis are 13 cases,suspected diagnosis are 78 cases.And using R * C table chi-square test to confirm the difference in diagnosis of patients with HILI in hospital of different clinical background,the results show that there are differences between Chinese and western hospital with HILI diagnosis(X2 = 10.917,P < 0.05).Analysis of 93 patients with suspected HILI,taking medicine only contains the Chinese native medicine ingredient for 27 cases(29%),taking proprietary Chinese medicine with western medicine ingredients for 3 cases(3.2%),combined with western medicine for 18 cases(19.4%).Analysis the clinical characteristics in 180 cases related to Chinese herbal medicine,the mainly traditional Chinese medicine causing liver damage are fleece-flower root and its preparation,the most common medicinal liquor and tripterygium wilfordii and its preparations of ChineseMedicine.HILI of lack of characteristic clinical manifestations,liver cell damage type,cholestasis type and mixed type each accounted for 77.2%,6.1% and 6.1%;The majority of patients is starting with symptoms of urine yellow and fatigue,most cases Performance for the digestive system symptoms,such as nausea oil,vomiting,poor appetite,and abdominal discomfort,a small number of them performance for allergic symptoms,such as chills fever,skin itching and rash.According to the severity of DILI classification standard,level 1,level 2,level 3 and level 4 and level 5 each accounted for 26.7%,13.3%,25%,26.1% and 2.2%,90% of the patients prognosis is good,the invalid or increase 9.4%,the death patients was 0.6%.Conclusion: The clinical diagnosis of HILI most rely on the experience of the medical staff,there are very strong subjectivity,the misdiagnosis rate is high,there are several reasons lead to misdiagnosis of HILI,different clinical background of Chinese and western different also is one of many reasons,therefore,we need to be more objective and more accurate diagnosis of Chinese herbal medicine related to liver damage.