| Objective:To investigate the clinical characteristics and the influence factors of prognosis of drug-induced liver injurye,which is expected to help clinicians understand the disease and improve the level of diagnosis and treatment.Methods:371 cases of drug-induced liver injurye in our hospital from 2015 to 2018 were collected and analyzed,including the patients’ sex,age,body mass index,underlying disease,allergy history,drinking history,liver injury drugs,clinical manifestations,laboratory tests,clinical type,severity of the disease.Besides,to analyse the factors influenced the prognosis of DILI.Results:(1)371 patients with DILI were included in the study.There were 258 cases(69.54%)of hepatocyte injury type,59 cases(15.90%)of cholestasis type and 54 cases(14.55%)of mixed type in terms of clinical type.There were 359 cases of acute DILI(96.77%)and12 cases(3.23%)of chronic DILI in terms of disease duration.There were 67 cases(18.06%)of "highly probable",227 cases(61.19%)of "probable" and 77 Case(20.75%)of "possible" in terms of RUCAM score.There were 213 cases(57.41%)with 1 grade,38 cases(10.24%)with grade 2,103 cases(27.76%)with grade 3,15 cases(4.04%)with grade 4 and 2 cases(0.54%)with grade 5 in terms of severity.(2)From 2015 to 2018,the annual composition of patients with DILI in hospitalizedpatients with liver disease was gradually increasing in our hospital.Among the 371 cases,there were 165 males and 206 females and the ratio of male to female was 1:1.25.The average age of patients with DILI was 47.90±16.10 years old,mainly concentrated on40-69 years old(221 cases,59.57%).The majority of(52.30%)DILI patients had a normal body mass index(18.5-23.99).10.24% of patients with DILI had diabetes,19.68% had gallbladder disease,and 28.03% had basic liver disease.23.18% of patients had tumors,17.25% had allergies,and 11.59% had alcohol abuse.(3)In our hospital,main medicines causing drug-induced liver injury were Chinese Medicinals(33.25%),anti-tumor drugs(17.63%),anti-microbial drugs(14.61%),and antipyretic analgesics(10.58%),of which single-agent cyclophosphamide(5.54%)was the most.(4)Most(74.39%)DILI patients had clinical symptoms.The main symptoms were fatigue(56.33%),loss of appetite(55.53%),jaundice(36.93%),nausea(29.92%),and bloating(23.18%).(5)The clinical type of DILI patients was mainly hepatocyte injury type.DILI patients with different clinical types had differences in age,tumor history,albumin,ALT,AST,ALP(P<0.05).Those DILI patients with ALT,AST increased were prone to hepatocyte injury(P 0.000),older were prone to cholestasis(P=0.01)and ALP in patients with cholestasis were significantly higher than mixed(P=0.000).Those DILI patients with a history of tumors and those with high albumin were prone to mixed(P=0.01,P=0.000).(6)The severity of DILI patients was mainly grade 1.Patients with different severity of DILI had differences in age,history of tumor,hepatobiliary disease,drinking history,and albumin(P<0.05).The severity of DILI patients who were older,had a history of drinking,had hepatobiliary disease,and had significantly decreased albumin was grade 4 and 5(P = 0.001,0.003,0.00,0.001,0.000,respectively).DILI patients with history of cancer were prone to liver damage of grade 1 or 2(P=0.00).(7)85.98% of DILI patients were cured or improved but 14.02% were unhealed or died.The risk factors of prognosis were age(OR=4.12,P=0.00),basic liver disease(OR=2.54,P=0.02),total bilirubin(OR=1.01,P=0.00)and cholestasis type(OR=4.04,P=0.01)and the degree of risk was age> cholestasis>basic liver disease>total bilirubin.Albumin was the protective factor of prognosis(OR=0.21,P = 0.00).Conclusion:A number of drugs could cause drug-induced liver damage.The morbidity was gradually ascending.It mainly happened to the middle-aged women.The clinical symptoms were not specific and clinical classification was mainly acute,hepatocyte injury type.Older patients with DILI were prone to cholestasis,ALP of cholestasis was significantly higher than it of mixed type,those DILI patients with history of tumors were prone to mixed.DILI patients with low albumin were prone to hepatocyte injury type and cholestasis type.The severity was mainly grade 1.Patients with DILI who were older,with drinking history,hepatobiliary diseases and low albumin were significantly higher in severity,and those with history of cancer were lower.Most patients with drug-induced liver injury had a good prognosis,but a minority of patients had a poor prognosis.Patients with DILI who were older,with basic liver disease,high TBIL,and clinical type of cholestasis had an increased risk of poor prognosis,while the higher albumin was good for the patients with the drug-induced liver injury. |
PDF Full Text Request