Retrospective Study Of 115 Cases With Drug-Induced Liver Injury

Objective:Trough retrospective study of one hundred and fifteen DILI cases diagnosed in our hospital from 2012-2015,we get a certain understanding on the epidemiology, pathogenesis, clinical manifestations, diagnostic criteria, treatment and prognosis of DILI,and to discuss the reasons of DILI in Chinese traditional medicine and research progress of traditional Chinese treatment in DILI.Methods:We collected the clinical data of one hundred and fifteen DILI cases including gender,age,incubation period,suspected drugs,clinical features,clinical classification,severity of DILI,traditional Chinese and Western treatment,prognosis and its influencing factors,and used SPSS 21 software to make a statistical analysis of them.Results:1.Distribution of gender and age:In this research,there were forty one males and seventy four females,and the proportions of them was 1:1.8.There were fifty four cases,fifty cases,twenty cases,one cases in the group whose age were between forty one to sixty,twenty one to forty,sixty to one hundred and zero to twenty.2.Incubation period:There were ninety one cases,ten cases in the group whose incubation period were between five to ninety days,ninety one to one hundred and eighty days.And there were seven cases in the group whose incubation p eriod were more than one hundred and eighty days,also as the group whose incubation period were less than five days.3.The drug kinds causing DILI:There were sixteen drug kinds causing DILI.The Traditional Chinese Medicine had the highest proportion(thirty-one point three percent),followed by Anti tuberculosis drugs(eleven point two percent),Antineoplastic Drug(eight point two percent),antibiotics(seven point five).Common Chinese patent medicines were Indigo Naturalis Pills,Keyin Pills,Anti nuclear Pills,Zhuanggu Guanjie Pills,Liushen Pills,Yangxue Shengfa Capsule,Vitiligo capsule and so on.4.The major clinical features:The major clinical features were asthenia,anorexia,abdominal discomforts,nausea and vomitting,jaundice,uncomfortable in the hepatic region,dry and bitter mouth.5.Clinical features:There were one hundred and seven cases of acute DILI and eight cases of chronic DILI.There were sixty four cases,twenty nine casesand twenty two cases of hepatocellular injury type,mixed type and cholestasis type.There were difference in the proportions of clinical classification between the group caused by Traditional Chinese Medicines and the group caused by Western treatment group(P<0.05).In the first group,the major clinical classification were hepatocellular injury type and cholestasis type;In the second group,the second clinical classfication were hepatocellular injury and mixed type;6.Traditional Chinese Medicine types: There were thirty one cases,fifty cases,nine cases,three cases in syndrome of stagnant and jamming dampness-heat,hepatosplenic disorder syndrome,syndrome of qi stagnation and blood stasis,syndrome of yin deficiency of liver and kidney.7.Biochemical examination: The spikes of ALT and AST of hepatocellular injury type were apparently higher than the another two types(P<0.05).The spikes of ALP and TBIL of cholestasis type were apparently higher than the another two types(P<0.05).But the spikes of PTA had no difference in them(P>0.05).8.DILI severity :There were fifty one cases,twenty seven cases?twenty two cases thirteen cases and two cases from DILI Grade one to five.There were no difference in the DILI severity of these three types(P>0.05).And the DILI caused by Traditional Chinese medicines were more serious than the types caused by Western medicines(P<0.05).9.DILF:There were fifteen cases diagnosed as DILF.The incidence rate was higher in which had hepatic elementary disease;Compared to Western Medicine,Traditional Chinese Medicine had a higher incidence rate(P<0.05).10.Prognosis:There were no difference in prognosis between Chinese and Western medicine treatment group and Western medicine treatment group(P>0.05).The prognosis of DILI was related to age and clinical classification.Multivariate logistic regression analysis showed that hepatocellular injury type and age were negatively related to the prognosis of DILI.Conclusion:In this research,the proportion of women was slightly higher than men,and the patients whose age between forty one and sixty had a higher morbidity than others.DILI was mainly caused by Traditional Chinese Medicine,but its pathogenesis that lead to DILI was not clear yet.It may be related to the direct liver toxicity of some components in traditional Chinese medicine and the immune mechanism leaded by the components.The incubation period of DILI varied in individuals.Its clinical features and biochemical examination had no specificity,so there are no diagnostic criteria of DILI at the present stage,We can use RUCAM scoring system as a reference,but it has imitations in the diagnosis of HILI,we can explore specific and sensitive markers to diagnose DILI rapidly.Hepatocellular injury type had the most cases,followed by mixed type and cholestasis type.Ttagnant and jamming dampness-heat,hepatosplenic disorder syndrome occured in majority in the Traditional Chinese Medicine types.The DILI severity were mainly mild and moderate,the DILI caused by Traditional Chinese medicines were more serious than the types caused by Western medicines,and the incidence rate was higher in which had hepatic elementary disease;Compared to Western Medicine,Traditional Chinese Medicine had a higher incidence rate.There were no difference in prognosis between Chinese and Western medicine treatment group and Western medicine treatment group,but Traditional Chinese Medicines had more advantages in treating primary diseases and improving symptoms.The prognosis of DILI was related to age and clinical classification.The greater the age,the worse the prognosis.And the prognosis of hepatocellular injury type was poorer than another two types.We should strengthen the propaganda of safety medication in clinical,use drugs appropriately and normatively,make a strict examination and approval of Traditional Chinese Medicines.call for the drugs which Liver injury had occurred from sale.In addition,making a prospective and retrospective study of multicenter,large samples and more strict to draw a more accurate and more consistent with the clinical practice is very necessary.The relationship between clinical manifestations and TCM syndrome differentiation should be studied and formulated in accordance with the criteria of diagnosis and therapeutic effect of TCM.Clinical physicians should improve the pharmacology and toxicology of traditional Chinese medicine to provide strong evidence for clinical medicine as soon as possible.