| OBJECTIVESResearch(1):To analyze the similarities and differences of clinical features and pathological manifestations of patients with liver injury caused by traditional Chinese medicine and western medicine.Research(2):To investigate the clinical characteristics and prognostic factors of patients with drug-induced liver failure,in order to provide reference for clinicians.METHODSResearch(1):We collected 615 hospitalized patients with drug-induced liver injury(DILI)in Beijing Ditan Hospital,Capital Medical University from August 2008 to May 2019 and with liver histomathological examination retrospectively.According to inclusion and exclusion,403 patients with DILI caused by traditional Chinese medicine or western medicine were included.The patients' age,gender,medication status,serological indexes,autoantibodies and pathological characteristics were recorded in detail,and the clinical manifestations and pathological characteristics of Chinese and Western drug-induced liver injury patients were compared.Research(2):Retrospective analysis was conducted on 221 inpatients with drug-induced liver failure(DILF)in Beijing Ditan Hospital affiliated to Capital Medical University from August 2008 to May 2019.According to the inclusion and exclusion criteria,77 patients with drug-induced liver failure(DILF)were included.Patients were divided into two groups according to whether their condition had improved or not upon discharge.The clinical characteristics of the two groups were analyzed,and the risk factors affecting the prognosis of patients with DILF were discussed.RESULTS1.Research(1)Results1.1 Among the 403 patients with DILI,247 cases(61.3%)were caused by traditional Chinese medicine(including Chinese herbal medicine and Chinese patent medicine),among which the single traditional Chinese medicine was mainly polygonum multiflorum,Panax notoginseng and Radix davidii,accounting for 5.3%,2.4%and 2.0%,respectively.Chinese patent medicines were mainly Gukang Capsules(5/247,2.0%)and Xianling Gubao Capsules(4/247,1.6%).156 cases(38.7%)of liver injury caused by western medicine,the top three were non-steroidal anti-inflammatory drugs(23.1%),antibiotics(14.7%),lipid-lowering drugs(4.5%)1.2 The average age of both the TCM group and the western medicine group was 47 years old,and the majority of them were female.The proportion of female in the TCM group was higher than that in the western medicine group,and there was no significant statistical difference between the two groups in age and sex composition ratio(P>0.05).In terms of liver injury types,there were 266 cases of liver cell injury type,15 cases of cholestasis type,32 cases of mixed type and 90 cases of abnormal liver biochemistry examination,accounting for 66.0%,3.7%,7.9%and 22.3%,respectively.There was significant difference between the two groups in liver cell injury type and abnormal liver biochemistry examination(P<0.05).According to the severity of liver injury,there were 190 cases(47.1%)in grade 1,62 cases(15.4)in grade 2,and 151 cases(37.5%)in grade 3 or above.There was no significant difference between the two groups(P>0.05).Compared with laboratory indexes,ALT level[420.4(192.1,783.6)vs 326.8(107.1,633.6)]and AST level[244.1(126.1,460.0)vs 180.4(90.2,408.5)]in TCM group were higher than those in western medicine group.There was statistical difference between the two groups(P<0.05),indicating that the liver enzyme increase was relatively obvious in patients with liver injury caused by TCM.In terms of autoantibodies,there were 201 cases(201/403,49.9%)with at least one positive autoantibodies,123 cases(123/247,49.8%)in the Chinese medicine group,and 78 cases(78/156,50.0%)in the western medicine group.Most cases were ANA positive.There were no significant differences in the positive rate of autoantibodies,the positive rate of ANA and the distribution of ANA antibody types between the two groups(P>0.05).In terms of pathological characteristics,there was a statistical difference in the formation of apoptotic bodies between the two groups(P<0.05).There was no difference between the two groups in the stage of liver inflammation and fibrosis(P>0.05).1.3 The positive rate of autoantibodies in 247 patients with HILI was 49.8%(123/247).Comparing the pathological characteristics of patients with positive autoantibodies and negative autoantibodies,it was found that the distribution of focal necrosis,fatty degeneration and cholestasis of liver cells were different between patients with positive autoantibodies and negative autoantibodies(P<0.05).The positive rate of autoantibodies was 50.0%(78/156)in 156 patients with pure western drug-induced liver injury.There were differences in the distribution of bridging necrosis of liver cells,neutrophils infiltration in portal area and interface inflammation between positive and negative patients with DILI autoantibodies(P<0.05).2 Research(2)Results2.1 Among the 77 patients with DILF,there were 24 males(31.2%)and 53 females(68.8%),with a male to female ratio of 1:2.2 and an average age of(43±17)years.The three most common pathogenic drugs of DILF were Chinese herbal medicine(33.8%),anti-tuberculosis drugs(27.3%)and antipyretic and analgesic drugs(11.7%).Among the 77 DILF patients in this group,77.9%(60/77)were of hepatocellular injury type,7.8%(6/77)were of cholestasis type,3.9%(3/77)were mixed,and 10.4%(8/77)were of abnormal liver chemical examination.2.2 According to the classification of DILF,there were 26 cases of acute liver failure(33.8%),45 cases of subacute liver failure(58.4%),2 cases of chronic acute liver failure(2.6%),and 4 cases of chronic liver failure(5.2%),among which 6 patients were examined by liver histology.Among these 6 patients,5 cases of subacute liver failure and 1 case of chronic acute liver failure were examined by liver histology.At the time of discharge,3 patients were improved and 3 patients did not meet the standard of improvement.2.3 Among the 77 patients with DILF,30 patients(30/77,39.0%)were in the improved group,and 47 patients(47/77,61.0%)were in the non-improved or death group.Baseline data of significance in univariate analysis were age,combined hepatic encephalopathy,type of medication,AST/ALT,TBil,Glo,TP,maximum INR,PLT,HCT,RBC,lymphocyte count,and EO#(P<0.05).Logistic multivariate regression analysis showed that hepatic encephalopathy(OR=5.768,95%CI:1.791-18.574,P=0.003),decreased lymphocyte count(OR=1.846,95%CI:1.008-3.130,P=0.023)and decreased RBC(OR=2.537,95%CI:1.048-6.145,P=0.039)were prognostic factors in patients with DILF.The area under the ROC curve was used to analyze the diagnostic efficiency.It was concluded that the area under the ROC curve and the sensitivity of erythrocyte count and lymphocyte count combined with hepatic encephalopathy in predicting the prognosis of DILF were higher than that of single diagnosis,but the specificity was not significant.CONCLUSIONS1 In this study,most of the injuries were caused by traditional Chinese medicine.The most common injuries were caused by traditional Chinese medicine,such as Polygonum multiflorum,Panax notoginseng and Rhizoma rotundii.The most common injuries were caused by patent Chinese medicine,such as Xianling Gubao Capsule and Gukang Capsule.The top three Western medicines were non-steroidal anti-inflammatory drugs,antibiotics and lipid-lowering drugs.2 The main type of DILI caused by traditional Chinese medicine and western medicine was liver cell injury,and most of them were grade 1.The levels of ALT and AST in patients with liver injury caused by Chinese herbal medicine were higher than those caused by western medicine.3 The pathological characteristics of DILI induced by traditional Chinese medicine and western medicine were similar.Apoptosis bodies were more common in patients with liver injury caused by traditional Chinese medicine.There may be no significant pathological difference between the two groups in liver inflammatory activity and degree of fibrosis.4.Hepatocyte focal necrosis,hepatocyte steatosis,and hepatocyte cholestasis are the most common pathological features in patients with liver injury caused by Chinese medicine with negative autoantibodies.However,liver cell bridging necrosis,neutrophil infiltration in portal area and interfacial inflammation were more prevalent in patients with liver injury caused by Western drugs with positive autoantibodies.5 The majority of patients with drug-induced liver failure are female.The top three most common pathogenic drugs are Chinese herbal medicine,anti-tuberculosis drugs and antipyretic and analgesic drugs.Most of them were hepatocyte injury.The main types of liver failure were acute liver failure and subacute liver failure.6 Hepatic encephalopathy,erythrocyte and lymphocyte count are prognostic factors in patients with drug-induced liver failure. |
PDF Full Text Request