| BackgroundDrug-induced liver injury (DILI) is one of the serious consequences of drug-induced adverse reactions, so most of clinical patients, physicians, pharmaceutical companies and government departments concerned about it. In some foreign clinical studies, a part of patients who are in the event of drug-induced liver injury, the liver biomarkers to can be gradually returned to normal in spite of continuing the drug. So the views of adaptive tolerance put forward, there is no similar reports in China. In addition, our previous studies found that the proportion of herbs that led to liver injury is very high. But the clinical observation of liver toxicity of Chinese herbal monomer components is rare. According to analyze the known toxic components of Chinese herbal medicine, we found that the Chinese herbal medicine which containing pyrrolidine alkaloids can cause hepatic veno-occlusive disease (HVOD).It is a special type of drug-induced liver injury. Therefore, it is necessary to conduct clinical studies to improve our knowledge on the specific types of drug-induced liver injury.ObjectiveTo provide more cases for the further studies. We analyze the clinical characteristics of the adaptive tolerance of drug-induced liver injury and the hepatic veno-occlusive disease caused by Chinese herbal medicine respectively in our hospital in recent 5 years.MethodsCollect the clinical records of specific types of drug-induced liver injury in our hospital in the recent 5 years by using standardized methods for registration and follow-up. There are 32 cases with adaptive tolerance and 11 cases with HVOD caused by Chinese herbal medicine. According to whether discontinue the drugs, we divided the patients into two groups named withdrawal group and continuing group respectively. Discuss the types of liver injury of adaptive tolerance and the relationship between liver injury and the time. Classify the severity grade of liver injury by clinical symptoms and liver biomarkers.Analyze the clinical manifestations, biomarkers and imaging features of patients with HVOD caused by herbs. And classify HVOD as a form of mild, moderate and severe by the clinical manifestation, treatment and outcomes.ResultsThere are 32 patients with adaptive tolerance of drug-induced liver injury.21 patients in continuing group,11 patients in withdrawal group. All of the 32 patients of adaptive tolerance are hepatocellular injury type. The overall incubation period is 16.59±13.05days(6～60days). The time of peak transaminase levels decreased to normal is 11.34±5.97 days (6～30 days). The incubation period of continuing group is 17.05±13.71 days(6～60 days). The time of peak transaminase levels decreased to normal is 11.20±5.92 days (6～30 days). The incubation period of withdrawal group is 16.46±12.09 days(6～43 days). The time of peak transaminase levels decreased to normal is 11.91±6.20 days(7～30 days). The degree of liver injury is grade 1 in 30 patients, and grade 2 in two patients.In all of the 11 HVOD patients, seven were taking gynura rhizome, two taking common threewingnut root and the other two taking the unknown Chinese herbal medicine. The liver present "map-like" or "patchy" enhancement and low perfusion changes by CT examination in all of the 11 patients with HVOD. The 11 patients with HVOD were divided into three types according to their clinical manifestations, management and treatment effect. One mild, four moderate and six severe.Conclusion Hepatocellular injury is the main type in patients with drug-induced liver injury who occurs the adaptive tolerance phenomenon. There is, no more than one month since the biomarker levels from peak decreased to normal. The severity of liver injury is no more than grade 2.According to the clinical and medication history, hepatic veno-occlusive disease can be screened by CT examination. Gynura rhizome is the main reason of hepatic veno-occlusive disease. The further study is necessary. |
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