Clinical Study On Characteristics And TCM Syndrome Differentiation Types Of 107 Patients With Drug-induced Liver Injury

ObjectiveTo explore the etiology,clinical characteristics,TCM syndrome differentiation types,treatment and prognosis of Drug-induced liver injury(DILI),improve the understanding of the early diagnosis and treatment of DILI,and provide a basis for the future clinical use of drugs and the prevention of the recurrence of adverse drug events.MethodsCollecting medical records of the patients diagnosed with DILI in The Second Affiliated Hospital of Zhejiang Chinese Medical University from September 2014 to January 2020,analyze the general conditions,types of drugs,clinical symptoms,laboratory examination,imaging examination,clinical classification,TCM syndrome differentiation types,severity and clinical outcomes.Results1.107 patients included 37 males(34.58%)and 70 females(65.42%),with an average age of 59.91 ± 15.93 years2.70 cases were caused by western medicine(65.42%)and 37 cases were traditional Chinese medicine and health products(34.58%).The top five western drugs were drugs for cardiovascular and cerebrovascular diseases,anti-infective drugs,anti-tumor drugs,antipyretic and analgesic drugs and hypoglycemic drugs.3.The main clinical manifestations were fatigue,poor appetite,jaundice,nausea and abdominal distension,and 24.30%of the patients had no obvious manifestations.4.In terms of clinical classification,78 cases(72.90%)were hepatocellular injury,12 cases(11.22%)were cholestasis,16 cases(14.95%)were mixed type,and 1 case(0.93%)were hepatic vascular injury.5.The ALT and AST of the hepatocyte injury type were significantly higher than that of the mixed type and the cholestatic type,and the GGT and ALP of the cholestatic type and the mixed type were significantly higher than that of the hepatocyte type However,there was no significant difference in the peak values of TBIL and INR in the three groups,and there was no significant difference in the biochemical indexes of DILI caused by western medicine and traditional Chinese medicine and health care products.6.Most of the severity was mild liver injury.There was no significant difference in the severity of different clinical types of DILI.7.The TCM syndrome differentiation types of DILI were Liver stagnation and Spleen deficiency syndrome,Dampness-heat j aundice syndrome,Liver and Kidney Yin deficiency syndrome,and Qi-stagnation and blood stasis syndrome,with 24 cases,17 cases,7 cases and 2 cases respectively.ALP,GGT and TBIL of Dampness-heat jaundice syndrome were significantly higher than other groups,and the severity was more serious.There was no significant difference in prognosis among the four syndromes.8.The treatment of DILI was mainly liver protection and symptomatic treatment,38 cases(35.51%)were cured,62 cases(57.94%)were improved,the total effective rate was 93.46%,and 7 cases(6.54%)were not cured.ConclusionsThe incidence of DILI was mostly seen in women and the elderly.DILI is mainly caused by western drugs,top five are drugs for cardiovascular and cerebrovascular diseases,anti-infective drugs,anti-tumor drugs,antipyretic and analgesic drugs,hypoglycemic drugs.The clinical manifestations of DILI were mainly digestive tract symptoms,and the clinical classification was mainly liver cell injury,with mild liver injury.The patients with history of Chinese herbal medicine and health care products and positive autoimmunity antibody had higher severity.The TCM syndrome types of DILI can be divided into Liver stagnation and Spleen deficiency,Dampness-heat jaundice,Liver and kidney Yin deficiency,and Qi-stagnation and blood stasis syndrome TCM syndrome differentiation and treatment of DILI should be based on the patient’s basic disease and emphasize patient-centered rather than DILI itself.The treatment of DILI was mainly liver protective drugs,and the overall prognosis was good.