Clinical Analysis Of Drug-induced Liver Injury

Research backgroundLiver is the largest metabolic organ and detoxification organ of human body,which is vulnerable to the damage of various drugs and/or metabolites entering human body.(Drug-induced liver injury,or DILI)refers to the human body in the process of drug use,due to drugs or its active metabolite direct toxic effect on the liver or liver diathesis of drugs and their metabolites reaction caused by the diseases that are the result of abnormal liver function damage.In recent years,along with our country economy development is rapid,the different kinds of new drugs to market,all sorts of dietary supplements,health care products,medicinereducing weight species emerge in endlessly,and people are paying more attention to their health problems,non-standard medical problem is common,the incidence of DIL increasing trend year by year.ObjectiveThrough the review and statistical analysis of the inpatient data of DILI patients in recent 11 years in our hospital,the clinical features of DILI patients were summarized,so as to enhance clinicians’ understanding of DIL and improve the diagnosis and treatment level of this disease.Materials and methodsCollected in January 2009-December 2019 medical record home page in the First Affiliated Hospital of Dalian Medical University diagnosed as "drug-induced liver damage","drug-induced hepatitis",the drug-induced liver damage of 287 cases of hospitalized patients and to analyze the characteristics of clinical disease,patient age,region,gender and basic diseases,bad living habits,be in hospital,and onset time,drug use,clinical manifestation,laboratory examination,clinical types,severity classification,RUCAM scale,treatment and prognosis,and statistical analysis was carried out on the part of the indicators.Results1.General information: among the 287 patients with DILI included in this group,83 were males and 204 were females.The ratio of males to females was 1:2.5,the incidence of DILI in females was higher than that in males.The oldest age was 79 years old,and the youngest was 11 years old,with an average age of 49.34±14.63,among them,136 patients aged 40-59 years old(47.4%)accounted for the main age group of DILI,among the 98 female patients(72.1%).DILI had the shortest length of hospitalization of 1 day and the longest length of hospitalization of 42 days,with an average length of hospitalization of 12.58 days.There were 248 cases of urban patients(86.4%),72 cases of male patients(29.0%),176 cases of female patients(71.0%).The incidence of DILI in both urban and rural women was higher than that in men,and the urban prevalence was higher than that in rural areas.There was no statistically significant difference between urban and rural areas(P>0.05).2.Poor living habits and underlying diseases in DIDLI patients: smoking: 31 cases(10.8%),alcohol consumption:15 cases(5.2%),hypertension: 51 cases(17.8%),diabetes :15 cases(5.2%),coronary heart disease :13 cases(4.5%),hepatitis(past and present): 21 cases(7.3%),fatty liver: 35 cases(12.2%),allergy history: 22(7.7%),Allergy drugs are mainly: penicillin,cephalosporin antibiotics and sulfonamides drugs.3.The onset time: most of the patients after onset time mainly concentrated in the5-90 d: 216 cases(75.3%).4.Suspicious drugs: lead to DILI drugs ranked top 5,respectively is: the traditional Chinese medicine,proprietary Chinese medicine,antibiotics and cold medicine,antitumor medicine,health care products,including traditional Chinesemedicines and proprietary Chinese medicine in the first place,mainly by the first birds,soil ingredients like notoginseng drug is given priority to,mainly to penicillin and cephalosporin antibiotics drugs and antifungal drugs is given priority to,cold medicines are mainly composed of acetaminophen composition drugs.5.Clinical manifestations,classification,classification and grading: the main clinical manifestations of DILI in this group were jaundice,followed by anorexia,fatigue,nausea,vomiting and other gastrointestinal symptoms,23.0% of the patients had no clinical symptoms.Among the 287 patients with DILI,hepatocellular type was the most common,with 249 cases(86.8%),13 cases(4.5%)of cholestasis type,and 25cases(8.7%)of mixed type.There were 148 cases(86.0%)of hepatocellular type in DILI caused by traditional Chinese medicine,8 cases(4.7%)of cholestasis type,16cases(9.3%)of mixed type;43 cases(81.1%)of hepatocellular type in drug-induced liver injury caused by antibiotics,3 cases(5.7%)of cholestasis type,7 cases(13.2%)of mixed type;36 cases(75.0%)of hepatocellular type in drug-induced liver injury caused by cold medicine,3 cases(6.3%)of cholestasis type,and 8 cases(16.7%)of mixed type;DILI caused by traditional Chinese medicine,antibiotics and cold medicine was mainly caused by hepatocellular type,and the proportion of DILI caused by traditional Chinese medicine was large,there was no statistically significant difference between traditional Chinese medicine,antibiotics,cold medicine and liver cell type(P>0.05).Serum test results showed significant differences between ALT,AST,ALP,GGT,INR,PT,EO and liver cell typing(P<0.05).There were no significant differences in length of hospitalization,age,ALB,TB,WBC,gender and liver cell type.The grade of DILI injury of 287 cases was mainly grade 1:191 cases(66.6%),most of which were mild,There was no statistically significant difference in the classification of traditional Chinese medicine,antibiotics,cold drugs and drug-induced liver injury(P>0.05).According to the DILI RUCAM scoring system,the score ratio was high,up to 253cases(88.2%),and there was no significant difference in the scores of traditional Chinese medicine,antibiotics,cold medicine and drug-induced liver injury(P>0.05).2liver biopsy indicated drug-induced liver injury.6.Treatment and outcome: DILLI immediately once the diagnosis of drug withdrawal,protect liver,fall enzyme,to yellow,artificial liver and blood plasma replacement therapy,function index varying degrees of improvement: clinical outcomes are divided into: better,cure,not cured,death,in this study,287 patients with DILI,after active treatment,improvement in 275 cases(95.8%),cured 7 cases(2.4%),4 cases were cured(1.0%),1 cases died(0.3%),mostly good prognosis after treatment,282 patients,cure for prognosis will be improved(98.3%),as poor prognosis of death was not cured,5 cases(1.7%),and prognosis with poor prognosis in the two groups with gender,age,medication(joint,single),no statistical difference,(P>0.05).One of the patients who died had a history of taking the health product guzhen pine pollen and traditional Chinese medicine ointment,and the clinical type was hepatocellular.Conclusion1.The most common age of DILI patients is 40-59 years old,and the incidence rate of female patients is higher than that of male patients.2.The incidence of DILI in urban and rural women was higher than that in men,and the urban prevalence was higher than that in rural areas(possibly related to the understanding of the disease and medical conditions),and there was no statistically significant difference between urban and rural areas and gender(P>0.05).3.March to DILLI drugs ranked top 5,respectively is: traditional Chinese medicine,proprietary Chinese medicine,antibiotics and cold medicine,antitumor medicine,health care products,including traditional Chinese medicines and proprietary Chinese medicine in the first place,the main is given priority to with what drug ingredients like the first bird,notoginseng,mainly by penicillin and cephalosporin antibiotics drugs and anti fungus is given priority to,really cold medicines are mainly composed of acetaminophen composition drugs.4.There was no significant correlation between DILI caused by Chinese medicine,antibiotics and cold medicine and liver cell typing,grade and score.5.287 patients with DILI in liver cell type is the most common,accounting for249 cases(86.8%),cholestasis type: 13(4.5%),mixed type: 25(8.7%),accounting for less than,liver cell type mainly in ALT,AST rise,high rates of nausea,vomiting,or no obvious symptoms,cholestasis type mainly increased ALP,GGT,jaundice(yellow,yellow urine)of skin mucous membrane high incidence,hybrid is above indicators are rising,clinical manifestation and liver cell type and cholestasis type symptoms.6.Most patients with DILI have good therapeutic effects.