Pathogeny And Analysis Of Clinical Characteristics In Liver Injury Patients With Notably Elevated Alanine Aminotransferase

BackgroundCauses of liver injury include viral hepatitis,nonalcoholic fatty liver disease,drug-induced liver injury,food poisoning,alcohol intake,autoimmune hepatitis.Moreover,the liver may be involved in systemic diseases,such as cardiovascular disease,connective tissue disease,blood system disease,lung disease.It is difficult to determine the cause of liver injury patients without characteristic symptoms only according to the indexes of liver function abnormalities,therefore cause of liver injury diagnosis has important significance to the clinical work.The diagnostic value of liver injury patients by alanine aminotransferase(ALT)deserves further studies.ObjectiveTo discuss differential diagnostic value of ALT through analysis of the change of ALT in liver injury patients of different etiologies,and further analyze the clinical manifestations of drug-induced liver injury(DILI)with notably elevated ALT.Methods1.Subjects: 1810 patients with ALT levels above 10 times upper limit of normal range(ULN).2.Groups: 1810 patients with liver injury were divided into(10-20)×ULN group(1132 cases)and upper 20×ULN group(678 cases)according to peak ALT level.1.Data collection: Liver injury patients with ALT level above 10×ULN were retrospectively analyzed on their clinical data covering 2013-01—2015-09,recording the general information,clinical manifestations,related history,laboratory tests,main treatment and surgical methods and other related information.4.Statistical analysis:The date were processed with SPSS 22 statistical software package,and P<0.05 was considered statistically significant.Results1.1810 cases of patients with ALT>10×ULN,455 cases of viral hepatitis patients(25.1%),265 cases of biliary hepatic injury(14.6%),300 case of drug-induced liver injury(16.6%),307 cases of hemodynamics of hepatic injury(17.0%),338 cases of the surgery of liver injury(18.7%),10 cases of autoimmune hepatitis(0.9%),8 cases of alcoholic liver injury(0.7%),19 cases of traumatic liver injury(1.7%),50 cases of unknown cause of liver injury(2.8%)and 41 cases of other types of liver injury(2.3%).2.In addition to ALP,comparing the ALT(10-20)×ULN group,the ALT>20×ULN group is higher in other laboratory indicators(P<0.05).3.Biliary liver injury and hemodynamic disorders induced liver injury resulted in a significant difference between ALT(10-20)×ULN group and ALT>20×ULN group(P<0.05).4.Hemodynamic disorders induced liver injury in ALT is higher than other causes of liver injury,autoimmune hepatitis is lower.5.Analysis of risk factors on severe and death of patients with liver injury by conditional logistic regression show that Age(P=0.000,OR=1.052)and Activated Partial Thromboplastin Time(APTT)(P=0.024,OR=1.049)are independent risk factors.6.300 cases of DILI(16.6%),277 DILI patients with complete clinical data.The possibility of the causality between suspected drug and liver injury were as follows: highly probable relevant(>8,15.8%),probable relevant(6-8,40.9%),possible relevant(3-5,43.3%).7.A hepatocellular pattern was observed in 182(80.0%)cases,mixed in 78(6.7%)and cholestasis in 17(13.5%),cure and improvement rate of hepatocellular type and mixed type was 85.2% and 91.0%,cholestasis is significantly lower in 52.9%(P=0.013,P=0.001).8.Liver injury severity:1(mild)146 cases(52.7%),2(moderate)28 cases(10.1%),3(moderate-severe)35 cases(12.6%),4(ALF)64 cases(23.1%),5(fatal)4 cases(1.4%).patients with mild liver injury in the mean ALT level is lower(P<0.05).9.Analysis of risk factors on severe and death of patients with liver injury by conditional logistic regression show that drugs(P=0.02),albumin(P=0.049,OR=0.87),alkaline phosphatase(ALP)(P=0.016,OR=1.005),lactate dehydrogenase(LHD)(P=0.018,OR=0.999),Activated Partial Thromboplastin Time(APTT)(P=0.024,OR=1.049)and Fibrinogen(FIB)(P=0.001,OR=0.292)are independent risk factors.10.The causes of DILI are Traditional Chinese Medicine(TCM),anti-tumor drug,anti-infective agents,analgesic-antipyretic,lipid-lowering drugs,anti-tuberculosis drugs,neurological and psychiatric medication.ConclusionThe change of ALT has directive significance for diagnosis of the cause of liver injury patients.Age,APTT are independent risk factors for Mortality in liver injury patients with notably elevated ALT,and ALT does not possess warning function.Drugs,Alb,ALP,LHD,APTT,and FIB are independent risk factors of severe and death in DILI with notably elevated ALT,and ALT does not possess warning function.The main causes of DILI in China are TCM,anticancer drugs,anti infective drugs.