Clinical Analysis Of Drug-induced Liver Disease

OBJECTIVE To investigate the drug-induced liver disease clinical features,in order to enhance clinicians to understand drug-induced liver disease.METHODS To retrospectively analy clinical data of 109 patients which is in our hospital during the period of 2002 -2008.RESULTS1.The general situation:There are 42 male patients and 67 female patients in 109 cases.Male to female is 1:1.60.3-year-old minimum age,maximum age 78 years old,the average age is 43.29 years old with a disability 16.28.The proportion(57.8%)of young and middle-aged group is the highest.Manual to mental is 1.73:1.There are 75 cases of incubation period＞12 weeks,which accounted for 68.8%.2.Pathogenic drugs:the type of pathogenic drugs which is used by 109 patients is 21.The drug caused DILD with the top four are:Chinese herbal medicine(34.4%),anti-TB drugs(14.7%), antibiotics(10.1%),antipyretic analgesic drugs(8.3%).38 patients used Chinese herbal medicine.There are 16 patients who used Chinese herbal medicine to treat skin disease.It accounted for 41%of the use of Chinese medicines.3.Clinical manifestations:six cases of asymptomatic(5.5%).103 cases of symptomatic(94.5%), mainly for the 85 cases of jaundice(75.2%),yellow color of urine 79 cases(72.5%),loss of appetite 73 cases(67%),72 cases of weak(66.1%),nausea in 45 cases(41.3%),fever 27 cases (24.8%),22 cases of abdominal distention(20.2%),22 cases of skin itching(10.2%),vomiting in 20 cases(18.3%),20 cases of lower extremity edema(18.3%),hepatosplenomegaly in 19 cases (17.7%),15 cases of dullness mobility(13.8%),14 cases of hepatic encephalopathy(12.8%),10 cases of skin rash(9.2%),the performance of five cases of bleeding(4.6%).4.Clinical classification:there are 73 cases of liver cell type(67.0%),12 cases of cholestasis type(11.0%),24 cases of mixed type(22.0%) in 109 patients,5.Laboratory tests:ALT and / or AST increased accounted for 97.2%.TB increased accounted for 93.6%.GGT and / or ALP increased accounted for 88.9%.PT%decrease and / or APTT extended accounted for 41.3%.Phypoproteinemia accounted for30.3%.Hypokalemia accounted for 15.6%.Urinary protein positive accounted for 13.8%.Blood BUN increased accounted for 6.4%.6.①DILD vesting after treatment:cure:36(33.0%);a turn for the better:60(55%);unless these: 11(10.1%);Death:2(1.8%).The overall mortality rate was 10.9%.The mortality rate of liver cell type is 15%.The mortality rate of cholestasis is 8.3%.The mortality rate of mixed is 4.2% mortality rate.②cure and improvement were classified as better prognosis group.Unless these and death is attributed to the poor prognosis group.The differences of TBIL level between the two groups is statistical.TBIL level of the poor prognosis group was significantly than that of the better prognosis group,While ALT,AST levels is not related to prognosis.③prognostic factors:age,sex,occupation,history of any allergies,the incubation period,the type of liver injury,ALT,AST,TBIL,ALP,GGT highest level conducting Logistic regression analysis results suggest that the highest level of TBIL is prognosis factor(13= 0.004,＜0.05,OR = 1.004).CONCLUSIONS1.The trend of DILD significantly increased in recent years.Age at onset in young and middle-aged group is more,accounting for 57.8%.The majority of drug induced liver disease appears within 3 months after eat medicine.2.The drugs caused liver damage were particularly prevalent in the Chinese herbal medicine, anti-TB drugs,antibiotics,antipyretic analgesic drugs.3.DILD does not have specific clinical manifestations.The liver cell-based is the most,which accounts for 67.0%.4.The majority of patients has good prognosis.The highest level of TBIL is prognostic factors, while age,sex,occupation,history of any allergies,the incubation period,the type of liver injury and the highest level of ALT,AST,ALP,GGT are not relevant to the prognosis.