Drug-induced Liver Injury:Analysis Of 170 Cases

Objective : To analyze the causes and clinical characteristics of drug-induced liver injury(DILI), and improve the understanding of the early diagnosis and treatment of DILI.Method : A retrospective study was conducted for 170 patients hospitalized in Tongji Hospital from January 1995 to August 2015 to analyze the general situation(age, gender), basic diseases, pathogenic drugs, clinical characteristics, classification, treatment and prognosis of patients.Result : There were 68 males and 102 females among 170 cases, with age 14 to 73 years old, on average 44.66±14.96 years old. Nearly half of all cases were among 40 to 59 years old, especially in females, accounting for 60.76% of this age group. Of 170 patients with DILI, 159(93.53%) took drugs owing to basic diseases, of which the most common diseases were tuberculosis, gastrointestinal diseases, osteoarthropathy, cardio-cerebral vascular diseases and skin diseases. The traditional Chinese medicine was the most common cause(50.59%), followed by anti-tuberculosis drugs(18.82%), antibiotics(11.76%), and drugs for treatment of hyperthyroidism(2.92%) and cardio-cerebral vascular diseases(2.92%). Among 86(50.59%) DILI patients induced by traditional Chinese medicine, the most common causes ordinally were the drugs for treatment of gastrointestinal diseases, osteoarthropathy, cardio-cerebral vascular diseases, skin diseases and tumors. Another 83(48.82%) DILI patients induced by western medicine, the most common causes ordinaly were anti-tuberculosis drugs, antibiotics, drugs for treatment of hyperthyroidism and cardio-cerebral vascular diseases and NSAIDs. The time of onset of DILI in majority of patients was within 8 weeks. The most patients were hepatocellular injury type, accounted for 90.59%(154/170), and cholestatic type and mixed type accounted for only 5.29%(9/170)and 4.12%(7/170). The major symptoms of hepatocellular injury type were fatigue, anorexia and jaundice, with serum ALT and AST levels significantly increased, and TBIL, DBIL and IBIL levels increased in some patients. The major symptom of cholestatic type was jaundice, with serum TBIL,DBIL,ALP and GGT levels significantly increased. The mixed type had the characteristics of both hepatocellular injury type and cholestatic type. The most patients were favorable prognosis with 12 cases(7.05%) cured and 150 cases(88.24%) brilliantly improved out of hospital, another 8 cases(4.71%) were discharged from hospital without recovery. No one patient died. The median length of hospital stay was 14.83±9.55 days.Conclusion : 1. The higher incidence of DILI was at age between 40 to 59, and in females the morbidity was much higher than in males.2. The most majority of patients took drugs owing to basic diseases, of which the most common diseases were tuberculosis, gastrointestinal diseases, osteoarthropathy, cardio-cerebral vascular diseases and skin diseases.3. The most common drugs induced DILI were the traditional Chinese medicine, anti-tuberculosis drugs, antibiotics, drugs for treatment of hyperthyroidism and cardio-cerebral vascular diseases.4. The traditional Chinese medicine was the first reason of DILI, of which the drugs for treatment of gastrointestinal diseases, osteoarthropathy, cardio-cerebral vascular diseases, skin diseases and tumors were most commonly used.5. The onset time of DILI in most majority of patients was within 8 weeks after using drugs.6. Hepatocellular injury type was the mainly clinical type of DILI.7. The majority of DILI patients had a good prognosis.