| Objective:The purpose is to compare and analyze the characteristics of different clinical types of drug-induced liver injury,and to provide reference for clinical judgment of type,severity and prognosis.Materials and Methods:This study included 222 patients admitted to hospital due to drug-induced liver injury from July 2018 to December 2020.Record the patient’s gender,age,length of stay in hospital,clinical manifestations,types of drugs and laboratory test results,etc.,compare the differences between the various types,and understand the clinical characteristics and treatment effects of each type.Compare the severity and prognosis,and summarize the characteristics of each classification.Results:1.There are 130 cases of hepatocellular injury,40 cases of cholestasis,45 cases of mixed type,and 7 cases of hepatic vascular injury.The type with the highest incidence is hepatocellular injury,followed by mixed type,cholestasis type.The lowest is hepatic vascular injury type.2.Age distribution: the median age of hepatocellular injury type is 51 years;the median age of cholestasis type is 54 years;the median age of mixed type is 52 years;the median age of hepatic vascular injury type is 61 years.Comparing the age of onset of the 4 groups was not statistically significant(P=0.138).The ages of the first three types were compared with the hepatic vascular injury type.The P values were 0.047,0.244,0.244.The age between the hepatocellular injury and the hepatic vascular injury is statistically significant,indicating that the age of hepatic vascular injury is older,and the age of onset of hepatocyte injury is younger.3.Gender distribution: The overall male to female incidence ratio of DILI was 1:2.3,with67 males and 155 females,which was statistically significant(P<0.001).There were significantly more females than males.In the hepatocellular injury type,there are 38 males and 92 females;in the cholestatic type,12 males and 28 females;in the mixed type,13 males and 32 females;in the DILI group with hepatic vascular injury,4 males,3 cases of female,no statistical significance(P=0.491),there is no significant difference in gender distribution between the types.4.Chinese herbal medicines and Chinese patent medicines,combination medications,health products,and antipyretic analgesics are the main causes of liver damage.Comparing the number of patients with Chinese herbal medicines,Chinese patent medicines,and combination medicines in the 4 groups,there was no statistical difference(P=0.052),and there was no significant difference in the types of medicines between the types.In addition to Chinese medicines with unknown ingredients,medicines for treatment of osteoarthritis,gastrointestinal diseases and Chinese medicines with clear ingredients of Panax notoginseng accounted for the main part.5.According to the severity of liver injury,patients were divided into 5 grades: mild,moderate,severe,liver failure and lethal.Chi-square test was used to show that the severity of DILI was statistically significant(P=0.007).The injury type is more serious than the other three types of liver injury.6.The absolute level of eosinophils of each type of DILI was analyzed and compared.There were 41 patients below the lower limit of normal,119 patients above the upper limit of normal,and 160 patients with abnormal eosinophils,accounting for the total of 72.07%.Comparing the absolute value of eosinophils between the various types,the difference was not statistically significant(P=0.262),indicating that there was no significant difference in the absolute value of eosinophils between the various types.7.The overall median hospital stay of patients is 10 days;the median hospital stay of patients with hepatocellular injury is 10 days;the median hospital stay of patients with cholestasis is 9 days;the median hospital stay of mixed patients is 9 days;the median hospital stay of patients with hepatic vascular injury is 20 days.The first 3 groups were compared with the hepatic vascular injury type,and the differences were statistically significant(P values were 0.02,0.02,0.017),indicating that the hospitalization time of the hepatic vascular injury type was longer than the other three types.8.In the hepatocellular injury type,there were 128 cured/improved patients,and 2unhealed/dead patients;in the cholestatic type,37 were cured/improved,and 3 were unhealed/dead;in the mixed type,all 45 cases were cured/improved;in the type of hepatic vascular injury,3 cases were cured/improved,and 4 cases were unhealed/dead.Analysis and comparison showed that the difference was statistically significant(P<0.001),and the prognosis of the hepatic vascular injury type was worse than the other three types of DILI.Conclusion:The characteristics of the four different clinical types of drug-induced liver injury are as follows:1.Among the four types,the type with the highest incidence rate is hepatocellular injury type,followed by mixed type,cholestasis type,and hepatic vascular injury type is the lowest.2.The overall prevalence of DILI is more female than male,but the age and male-tofemale ratio of DILI patients are similar among different types.3.Chinese herbal medicines and proprietary Chinese medicines,multiple medications,health care products,and antipyretic analgesics are the main causes of DILI.4.Most patients with DILI have abnormal eosinophils,but there is no significant difference in the absolute level of eosinophils between the various types.5.Compared with the other three types of liver injury,the severity of hepatic vascular injury is more serious,the hospital stay is longer,and the prognosis is worse. |
