| PurposeBased on the epidemiological investigation and prognosis of the clinical medical records in our hospital during the last 5 years, the Chinese herbal medicine and its preparations, clinical features, diagnostic methods and treatment outcome of acute liver injury were investigated;The patients were followed up to evaluate the prognosis of patients with acute liver injury in Chinese herbal medicine, and provide new data for clinical safety monitoring of Chinese herbal medicine.MethodsFrom 2010 January to January 2015 hospitalized cases, a total of 160713 cases. The diagnosis of 263 cases of cases of acute drug induced liver injury and the screening out of 71 cases of herbal medicine in acute liver injury, each of the cases according to the standard of case investigation form to register,71 cases of acute liver injury were selected from the Chinese herbal medicine, and each case was registered according to the standardized case questionnaire,By reviewing the records of patients with liver injury of age, gender, body mass, primary disease, medication types, measurement, route of administration, symptoms, clinical manifestations, laboratory examination (liver function, coagulation function etiological examination), drug-induced liver injury and outcome of treatment, system summary analysis, the rucam scoring system, the Association of quantitative score for each case report. And by telephone or outpatient way to agree to participate in the follow-up of patients were followed up, record monthly check liver biochemical and understanding of liver biochemical recovery or aggravate the process.Results1?A total of 263 cases of acute drug-induced liver injury in our hospital during the past 5 years, accounting for 0.16% of all cases;Excluding incomplete data 6 cases, the actual available for analysis of a total of 257 cases, of which 186 cases of drug induced liver injury, accounting for 72.4% of acute drug-induced liver injury cases;Acute liver injury in 71 cases, accounting for 27.6% of cases of acute drug-induced liver injury, and acute Chinese herbal medicine liver injury patients have an increasing trend year by year.2?General situation 71 cases of patients with an average age of 46.3+14.3 years, of which more than 55 years old in 21 cases (29.6%), weight 61.0kg+9.1kg.Women were 41 cases,30 cases of male patients, the ratio of male to female was 1:1.5, and the proportion of female patients was significantly higher than that of males.Body weight and ALT recovery rate was positively correlated, that is, the heavier the weight of ALT recovery rate, age, gender and liver injury type, prognosis, liver function index were not related.3?Drug induced liver injury Oral Chinese herbal medicine treatment of the underlying disease in digestive system diseases accounted for the highest of all the basic diseases of 33.8%, secondly for diseases of the respiratory system and cardiovascular system diseases accounted for 22.5% of oral Chinese herbal medicine treatment of the underlying disease,9.9%.Liver cell type 60 cases accounted for 84.5% of all liver injury clinical typing and mixed type 7 cases, accounting for all liver injury clinical typing of 9.8%, cholestasis type 3 cases accounted for 4.2% of all liver injury clinical typing, clinical liver damage divided between bilirubin and transaminase levels did not statistically significant.4?Clinical Manifestation With no symptoms, jaundice, abdominal distension, nausea, nausea and other gastrointestinal symptoms, such as nausea, fever, rash, itching and other systemic manifestations.5?RUCAM Scoring System Patients with acute herbal liver injury in height, possibly in 2 cases accounted for only 2.0% of herbal medicine in acute liver injury, likely to be 35 cases (37.4%),32 cases (34.4%), less likely in 21 cases (21.2%), independent of7cases accounting for 7% of acute medicine related liver injury, excluding score< 3 points in 28 cases, and therefore,71 cases were included in the analysis,69.7% of cases is very likely and possible suspected level.6?Chinese herbal medicine suspected of causing liver damage In 71 cases of acute Chinese herbal medicine related liver injury cases,64 cases of liver injury caused by the Chinese traditional medicine, accounting for 90.1% of all Chinese herbal medicine related liver injury patients, and a total of 45 kinds of traditional Chinese medicine, a total of kinds of drugs.Decoction of Chinese medicine to liver injury only 7 cases and the drug composition is complex. In 64 cases with traditional Chinese medicine in patients of drug induced liver injury:non TCM prescription medication in 49 cases accounted for 76.6% of all prescription, doctor of traditional Chinese medicine 15 cases accounted for 23.4% of all prescriptions.7?Prognosis Included in the case of a patient who was diagnosed with an illness allowed to stop taking the drug or suspected loss of liver drugs,To no jaundice simply elevated transaminases withdrawal, reduced glutathione, compound glycyrrhizin and drug treatment, patients after discontinuation of the drug in the alt, AST and the most obvious decline, mostly within four weeks of patients with liver function returned to normal. Serum bilirubin in patients with decreased time relatively later than ALT? AST.8?Follow-up Clinical data and follow-up results in 41 cases of acute Chinese herbal medicine related liver injury were included in the follow-up of patients with drug-induced liver injury. The average age was 44.9+14.3 years old, including 17 males and 24 females.Mixed type (9.8%),3 (4) patients with cholestasis type (7.1%), liver cell type 34 (82.9%).RUCAM scores were very likely in 0 cases, very likely in 18 cases (43.9%), possibly in 23 patients (56.1%).Clinical symptoms:no symptoms in patients with 16 cases accounted for 39% of all cases, gastrointestinal symptoms. A total of 21 cases (51.2%) followed by nausea, vomiting in 4 cases (9.8%),9 cases of abdominal pain and distension (22%),8 cases of anorexia (19.5%),8 cases of weakness (19.5%), jaundice in 6 cases (14.6%),2 cases of dizziness,1 case of fever (2.4%), drug eruption in 2 cases (4.8%), eosinophil eosinophil increase in 19 patients (46.3%).Long term follow-up study of acute drug induced liver injury, only 4 cases in the course of follow-up to take suspicious drug again Lei Gongteng liver function abnormalities, I have no chronic abnormalities, no severe hepatitis and death.ConclusionWith the increasing amount of clinical operations, services to people in the condition of the increasingly complex, the continuous progress of clinical detection means.5 years of herbal medicine in acute hepatic injury in our hospital hospitalization diagnosis rate was gradually rising trend should be to strengthen the attention and research, but in general here did not find serious adverse events, suggesting that Chinese herbal medicine has high security.Research shows:(1) Safety of Chinese herbal medicine was higher than that of Western medicine. Chinese herbal medicine related liver injury cases occur much less frequently. This set of data shows that, all cases of drug-induced liver injury, western medicine accounted for 72.4%. traditional Chinese medicine accounted for 27.6%. traditional Chinese medicine was significantly lower than that of western medicine, in roughly the same medical environment. Chinese herbal medicine related liver injury only 38.2% of the western medicine of the drug-induced liver injury.(2) Chinese herbal medicine related liver injury on the prognosis of better:This set of data shows that. Chinese herbal medicine related liver injury to liver cell type, mild to moderate majority, clinical prognosis better recovery faster, and liver function recovery time and the age of patients, gender, types of liver injury was not found no severe acute drug-induced liver injury, no death. Follow up study confirmed that most of the cases can be in a short period of time can be completely restored to normal, the prognosis is good.(3) Lead to drug of Chinese herbal medicine related liver injury questionable: according to rucam scoring system, the study about 69.7% in herbal medicine related liver damage cases, drugs and liver injury in "suspected" level ("may" or "very likely"). Thus, the result in grass resistance associated liver injury specific Chinese herbal medicine, traditional Chinese medicine to be further confirmed that the observed clinical diagnosis still need to be cautious and avoid the limitations of "non Western medicine is medicine routine diagnostic thinking.(4) The level of syndrome differentiation and treatment on whether to produce the effect of Chinese herbal medicine liver injury is very significant. This set of data shows that, in roughly the same medical environment. "Chinese medicine practitioners" and Western medicine practitioners "at the same time the use of the same medicine bureau of Chinese herbal medicine, the former caused by Chinese herbal medicine of liver injury is far lower than that of the latter.(5) Compared with the use of herbal medicine, the use of proprietary Chinese medicines cause more medication risk. This group data show that, compared with the use of herbal medicine, the use of proprietary Chinese medicines may lead to more Chinese herbal medicine related liver injury, may with the former more emphasis on treatment based on syndrome differentiation, which pay more attention to the "treatment based on disease differentiation", suggesting that even when using traditional Chinese medicine to "treatment based on syndrome differentiation in order to further improve the safety of medication.(6) Through to the hospital during the past 5 years clinical data of survey, indicating that the Danshu capsules, Xiaoyanlidan tablets, Yunnan Baiyao, Tripterygium wilfordii lead to liver injury is the most common, prompted the use of these drugs when more attention should be paid to the relevant norms, pay attention to the monitoring of liver function. |
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