Drug-induced Liver Injury: A Clinical Analysis Of 38 Cases

Background:Some of the most severe drug reactions affect the liver.As our aging world population uses more and more drugs,chances of Drug-induced liver injury(DILI) are rising.DILI due to prescription and nonprescription medications including some traditional Chinese herbal medicine is a growing medical and social issue worldwide,and is now the leading cause of acute liver failure(ALF) exceeding all other causes combined,which accounts for approximately 10%-52%of cases in western countries,the mortality is about 11.9%.More than 10%-15%of drug side effects present as liver injury,exceeding all other manifestations except skin and mucosa damage or fever caused by drugs.It can clinically mimic nearly all forms of acute and chronic liver disease ranging from asymptomatic aminotransferase elevations,to microvesicular steatosis,cirrhosis and massive hepatic necrosis with liver failure.To our knowledge,thousands of drugs, Chinese herbs included have been known to be hepatotoxic.In China,several relative multi-centre studies on DILI are ongoing,there is a critical need to develop an improved means of detecting,defining,and studying drug-induced liver injury in our country.Aim:The object of this study is to analyze the clinical characteristics of DILI and improve the accuracy of its diagnosis and treatment.Method: Thirty-eight patients with suspected DILI dates from May 2008 to March 2009 were enrolled.This report summarizes their drug-taken history,clinical symptoms,liver function,serum biomarkers,UGA and the clinical presentation after withdrawal of the suspected drugs and investigates the drug types,the clinical manifestation,the feature of liver injury and their relationships with prognosis.Result:Traditional Chinese medicine(55.3%),antituberculosis agents(13.2%),antineoplastic drugs(7.9%),antibiotics(7.9%),lipid-lowering agents(5.3%),health supplement (5.3%),antipyretic analgesics(2.6%),and antithyroid drugs(2.6%) can cause DILI, 89.5%of them occurred in 2 months after drug administration.The types of liver injury in of 38 cases were as follows:39.5%hepatocellular type,34.2%mixed type and 26.3%cholestatic type.Severe liver injure happened in 13.2%of all the 38 patients,2 of them were cholestatic liver injury type,1 was hepatocellular injure type,and the other 2 were mixed type.Conclution:DILI is caused by a wide array of medications,traditional Chinese medicine and antituberculosis agents are the largest class of agents causing DILI in the patients admitted to our hospital.Cholestatic liver injury type and mixed type can cause more severe pathological changes of liver than the hepatocellular type.