Efficacy Analysis Of Anti-inflammatory And Hepatoprotective Drugs In The Treatment Of Drug-induced Liver Injury

Objective(s):To analyze the clinical data of hospitalized patients with drug-induced liver injury(DILI)in the recent 6 years and explore the prognostic factors.Methods:Collect the clinical data of DILI patients in a tertiary hospital from 2014 to 2020,and retrospectively analyze the age,gender,underlying diseases,clinical symptoms,suspicious drugs and route of administration,severity grading,laboratory tests,and liver protection drugs that caused DILI to use conditions and clinical efficacy,analyze the prognostic results and factors that affect the prognosis.Results:1.A total of 222 DILI patients were collected,and 72 DILI patients were finally enrolled,including 16 males and 56 females,with a male-to-female ratio of 1:3.5;the median age of the patients was 41 years old,mainly between 21 and 40 years old(31 cases,43.06%);Most patients with a low level of medication education(25 cases,34.72%);the BMI of most patients is within the normal range;smoking and drinking were 13.89%and 1.39%;9 patients with history of allergies(12.5%);24 patients with gynecological diseases(33.33%),8 patients with respiratory system diseases(11.11%),and 8 patients with endocrine system diseases(11.11%).2.The main symptoms of DILI patients are anorexia,fatigue,yellowish skin and sclera,greasiness,nausea,etc.The main clinical type is hepatocellular injury type(55 cases,76.39%),followed by mixed and cholestasis type;The scoring results of RUCAM were 6 points with 25 patients(34.72%),7 points with 17 patients(23.61%),8 points with 10 patients(13.89%),9 points with 18 patients(25.00%),and 10 points with 2 patients(2.78%).3.The drugs most likely to cause DILI are traditional Chinese medicine,followed by antitumor and antibacterial drugs,accounting for 38.89%,36.11%and 5.56%respectively;the route of administration is mainly oral(59.72%);the severity is mainly grade 1,accounting for 54.17%,and most patients have the milder disease;the biochemical indicators of liver function are mainly manifested as abnormal ALT and AST;liver protection drugs are mainly used in combination with more than two combinations;the cured,improved and effective patients accounted for 48.62%.4.The results of the univariate analysis showed that,the occupation,underlying disease,route of administration,initial ALP,initial AST,initial GGT,initial TBEL,ALT peak,ALP peak,AST peak,GGT peak,TBIL peak,and ALB peak of DILI patients have statistically significant effect on the prognosis of DILI patients(P<0.05).Multivariate Logistic regression analysis showed that low level of medication education,traditional Chinese medicine,and GGT peak were negatively correlated with patient prognosis(P<0.05).Respiratory and digestive diseases,initial TBIL,initial GGT,and ALB peak were positively correlated with patient prognosis(P<0.05).Conclusion(s):Many kinds of drugs can cause DILI,the clinical manifestations lack specificity,and the prognosis of most patients is good.The prognosis of patients is poor when the level of medication education is low and the suspected drug in traditional Chinese medicine.The higher the GGT peak,the poorer the prognosis of patients.When the underlying diseases are respiratory system diseases or digestive system diseases,the patients' prognosis is good,and the higher the ALB peak,the better the patients' prognosis.Doctors and pharmacists should further strengthen their understanding of the clinical characteristics of DILI,pay attention to the safety of DILI patients,improve the level of drug education,and promote the rational clinical use of drugs.Objective(s):To evaluate Ihe effectiveness and safety of anti-inflammatory and hepatoprotective drugs(diammonium glycyrrhizinate,compound glycyrrhizin,bicyclol)in the treatment of liver injury caused by antipsychotic drugs.Methods:Search the Cochrane,PubMed,Embasea CBM,CNKIa VIP,and Wan Fang Data to collect randomized controlled trials of anti-inflammatory and hepatoprotective drugs in the treatment of liver injury caused by antipsychotic drugs.Filter documents and extract data according to inclusion and exclusion criteria.Meta-analysis was conducted using Rev Man 5.3 software.Results:A total of 11 randomized controlled trials were included,with a total of 862patients:1.In terms of total clinical efifective rate: The total clinical effective rate of the anti-inflammatory and hepatoprotective drug group in the treatment of liver injury caused by antipsychotic drugs is higher than that of the other positive liver protection drug groups,and the difference is statistically significant [OR=6.22,95% Cl(3.54,10.94),P<0.00001];2.ALT: the anti-inflammatory and hepatoprotective drag group can significantly reduce the level of ALT in patients with DILI caused by taking antipsychotic drugs,and the difference is statistically significant [MD=25.22,95 % CI(-36.57,-13.87),P<0.0001];3.ATS: the anti-inflammatory and hepatoprotective drug group can significantly reduce the level of AST in patients with DILI caused by taking antipsychotic drugs,and the difference is statistically significant [MD=-16.07,95%CI(-25.27,-6.86),P=O.0006];4.In terms of safety: there is no statistically significant difference in the incidence of adverse reactions between the anti-inflammatory liver protection drug group and other positive liver protection drugs in the treatment of DILI caused by antipsychotic drugs [OR=1.01,95% CI(0.57,1.80),P=0.97];Conclusion(s):Compared with other hepatoprotective drugs,anti-inflammatory and hepatoprotective drugs can significantly improve the clinical efficacy of liver injury caused by antipsychotic drugs and improve various indicators of liver fimction.The incidence of adverse reactions is not statistically different compared with other hepatoprotective drugs.