| BackgroundDrug induced liver injury(DILI)refers to liver damage caused by the toxic effects of drugs and/or their metabolites,or allergic reactions of special constitutions to drugs during the use of drugs.DILI is a common adverse drug reaction that can cause liver failure and even death.With the updating of pharmaceutical technology and the continuous advent of new drugs,DILI has become a common health problem in the population,and is the main consideration for drug delisting.It is also the most common cause of acute liver failure(ALF)in the United States,accounting for more than 50%of cases,and DILI has drawn increasing attention in the past few years.A population-based prospective study from Iceland found that the incidence of DILI is estimated to be 19/100,000,and the annual incidence of acute severe liver injury requiring hospitalization is estimated to be 0.7-1/100,000.Our country has a large population,people lack awareness of safe medication,and clinicians have irregular medication practices.DILI is an exclusive diagnosis and lacks clear diagnostic criteria.Therefore,DILI is increasingly considered a challenging disease.ObjectiveThe study was conducted to explore the drugs that commonly caused DILI,clinical characteristics,typing,treatment,and prognosis in order to improve clinicians' understanding and diagnosis of DILI.MethodsA retrospective analysis was conducted in 126 patients diagnosed with DILI enrolled in our hospital from December 2017 to July 2019.The relevant data of hepatocyte type,cholestasis type and mixed type were compared to explore the characteristics of different types.The patient were divided into the recovery group and the Non-recovery group according to the efficacy of the 6-month follow-up,and the two groups were compared to explore the factors of DILI.Results1.Of the 126 DILI patients,49 were male and 77 were female.The ratio of male to female was 1:1.57.The age of the patients ranged from 9 years old to 77 years old,with an average age of was 45.74±14.38 years old.The age of high:incidence was 41-60 years old.2.Hepatocellular type was the most common type of liver injury(61.9%),followed by mixed type(26.2%),and cholestasis type was the least(11.9%).There was no statistically significant difference in the average age,onset latency,hospitalization time,history or drinking history among the three groups(P>0.05);chronic liver injury was statistically different between the three groups(P=0.013),and the cholestasis type was more likely to cause chronic liver injury.3.The common symptoms of patients with DILI when admitted to the hospital were jaundice(80.16%),digestive symptoms(42.86%),fatigue(14.29%),fever(9.52%),and asymptomatic(21.7%).Digestive symptoms were more common in Hepatocellular type(P=0.035),and jaundice was common in Cholestasis type(P=0.001).4.The most common causes of DILI are herbs(42.86%),followed by proprietary Chinese medicines(17.46%),antibiotics(12.69%),health drugs(7.14%),non-steroidal anti-inflammatory drugs(6.35%),and endocrine(4.76%),lipid-lowering drugs and antitumor or immune drugs(3.17%),and antiepileptic drugs(2.38%).Anti-tuberculosis drugs(P=0.007)and endocrine drugs(P=0.013)were significantly related to the clinical classification of DILI,while the three clinical classifications of Chinese herbal medicine were not significantly different.5.The laboratory indexes ALT,AST,GGT and ALP were statistically significant(P<0.05),and TBIL,DBIL and INR were not statistically significant(P>0.05).Compared with the Cholestasis type and the Mixed type,the ALT and AST of the Hepatocellular type increased significantly(P<0.05),but there was no statistical difference between the Cholestasis type and the Mixed type(P>0.05);ALP and GGT were significantly higher than Hepatocellular type and Mixed type(P<0.05),and Mixed type was higher than Hepatocellular type(P<0.05).6.Liver biopsies were performed in 17 patients,including 3 with acute liver injury(17.65%)and 14 with chronic liver injury(82.35%).Watery degeneration of hepatocytes was observed in all cases.There were 10 cases caused by Chinese medicine and 7 cases caused by western medicine.7.27 patients(21.43%)were not recovery(including chronic liver injury and liver failure),and 99 patients(32.1%)were recovery.Univariate analysis found that fatigue,AST,ALP,GGT,TBIL,herbal medicine,antibiotics,and clinical classification of liver injury were associated with poor prognosis(P<0.05).8.Multivariate regression analysis found that:symptoms of fatigue,TBIL and DBIL are independent risk factors for poor prognosis with DILI(OR fatigue=1.126,P=0.046;OR TBIL=1.148,P=0.020;OR DBIL=1.061,P=0.026).Conclusion1.Hepatocyte injury type was the most common type of DILI,and chronic liver injury was more common in cholestasis type..2.The most common symptom of DILI was jaundice.Digestive symptoms were more common in Hepatocellular injury type.Jaundice was more common in Cholestasis type.3.Chinese herbal medicines are the most common drugs that cause DILI,and liver damage caused by anti-tuberculosis drugs cannot be ignored.4.Single factor analysis found that fatigue,AST,ALP,GGT,TBIL,herbal medicine,antibiotics and clinical classification of liver injury were associated with prognosis of DILI.Multivariate analysis found fatigue symptoms,TBIL and DBIL are independent risk factors for poor prognosis of DILI. |
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