Objective To analyze and summarize the clinical data of drug-induced liver injury (DILI) , and to investigate the clinical features and prognosis of DILI. Methods A retrospective analysis was performed for the clinical data of 95 patients with DILI who were admitted to The First Affiliated Hospital of Xi'an Medical University from February 2010 to February 2016, including sex, age, medication history, underlying diseases, clinical manifestation, laboratory and imaging findings, treatment, and prognosis. A logistic regression analysis was used to investigate the influencing factors for prognosis. Results Respiratory system diseases ranked first among the underlying diseases treated by drugs that caused DILI and accounted for 25. 26% (24/95) , and of all patients, 23. 16% (22/95) had tuberculosis. Among the drugs that caused DILI, traditional Chinese medicine ranked first and accounted for 44. 21% (42/95) , followed by antitubercular agents which accounted for 22. 11% (21/95) . DILI often occurred within 15-30 days of medication. Poor appetite was the most common symptom of DILI, and jaundice was the most common positive sign. Elevated alanine aminotransferase was the most common laboratory result of DILI.Acute hepatocellular injury type was the most common type of DILI. Most DILI patients had good prognosis, and patients with response to treatment accounted for 95. 79% (91/95) , including those who were improved or cured. Age (odds ratio [OR]= 0. 054, 95% confidence interval (CI) : 0. 002-0. 076, P = 0. 037) , alkaline phosphatase (OR = 0. 004, 95% CI: 0. 001-0. 006, P = 0. 043) , total bilirubin (OR = 0. 028, 95% CI: 0. 001-0. 039, P = 0. 035) , and direct bilirubin (OR = 0. 008, 95% CI: 0. 001-0. 014, P = 0. 036) were independent risk factors for prognosis. Conclusion DILI does not have specific clinical manifestations and can easily be missed or misdiagnosed. Clinicians should use drugs rationally, monitor the presence of hepatotoxicity, and strengthen the public health education on safe medication.
[1]BJRNSSON ES.Hepatotoxicity by drugs:The most common implicated agents[J].Int J Mol Sci, 2016, 17 (2) :224.
|
[2]Drug-induced Liver Disease Study Group, Chinese Society of Hepatology, Chinese Medical Association.Guidelines for the management of drug-induced liver injury[J].J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.
|
[3]DEVARBHAVI H, PATIL M, REDDY VV, et al.Drug-induced acute liver failure in children and adults:Results of a single-centre study of 128 patients[J].Liver Int, 2017.[Epub ahead of print]
|
[4]TESCHKE R, FRENZEL C, WOLFF A, et al.Drug induced liver injury:Accuracy of diagnosis in published reports[J].Ann Hepatol, 2014, 13 (2) :248-255.
|
[5]CHALASANI NP, HAYASHIL PH, BONKOVSKY HL, et al.ACG Clinical Guideline:The diagnosis and management of idiosyncratic drug-induced liver injury[J].Am J Gastroenterol, 2014, 109 (7) :950-966.
|
[6]SGRO C, CLINARD F, OUAZIR K, et al.Incidence of drug-induced hepatic injuries:A French population-based study[J].Hepatology, 2002, 36 (2) :451-455.
|
[7]BJRNSSON ES, BERGMANN OM, BJRNSSON HK, et al.Incidence, presentation, and outcomes in patients with drug-induced liver injury in the general population of Iceland[J].Gastroenterology, 2013, 144 (7) :1419-1425.
|
[8]CHALASANI N, BONKOVSKY HL, FONTANA R, et al.Features and outcomes of 899 patients with drug-induced liver injury:The DILIN prospective study[J].Gastroenterology, 2015, 148 (7) :1340-1352.
|
[9]HU Q, LIU W, SHAO H.Research progress of pharmacotherapy drug-induced liver injury[J].Chin J Clin Pharmacol Ther, 2016, 21 (2) :231-236. (in Chinese) 胡琴, 刘维, 邵宏.药物性肝损伤的药物治疗研究进展[J].中国临床药理学与治疗学, 2016, 21 (2) :231-236.
|
[10]SUTTI S, TACKE F.Liver inflammation and regeneration in drug-induced liver injury:Sex matters[J].Clin Sci (Lond) , 2018, 132 (5) :609-613.
|
[11]AMACHER DE.Female gender as a susceptibility factor for druginduced liver injury[J].Hum Exp Toxicol, 2014, 33 (9) :928-939.
|
[12]LUCENA MI, ANDRADE RJ, KAPLOWITZ N, et al.Phenotypic characterization of idiosyncratic drug-induced liver injury:The influence of age and sex[J].Hepatology, 2009, 49 (6) :2001-2009.
|
[13]ZHOU SM, JIA J.696 cases of drug-induced liver injury[J].Drug Eval, 2007, 4 (6) :442-443. (in Chinese) 周世明, 贾杰.696例药物性肝损害药物的临床分析[J].药品评价, 2007, 4 (6) :442-443.
|
[14]LEISE MD, POTERUCHA JJ, TALWALKAR JA.Drug-induced liver injury[J].Mayo Clin Proc, 2014, 89 (1) :95-106.
|
[15]ZHOU Y, YANG L, LIAO Z, et al.Epidemiology of drug-induced liver injury in China:A systematic analysis of the Chinese literature including 21, 789 patients[J].Eur J Gastroenterol Hepatol, 2013, 25 (7) :825-829.
|
[16]ZHU Y, NIU M, CHEN J, et al.Hepatobiliary and pancreatic:Comparison between Chinese herbal medicine and Western medicine-induced liver injury of 1985 patients[J].J Gastroenterol Hepatol, 2016, 31 (8) :1476-1482.
|
[17]LIU CH, ZHU CW.Epidemic features, major causes, and diagnostic evaluation of herb-induced liver injury[J].J Clin Hepatol, 2017, 33 (5) :829-832. (in Chinese) 刘成海, 朱春雾.中草药相关药物性肝损伤的流行特点、主要原因与诊断评估[J].临床肝胆病杂志, 2017, 33 (5) :829-832.
|
[18]STICKEL F, SHOUVAL D.Hepatotoxicity of herbal and dietary supplements:An update[J].Arch Toxicol, 2015, 89 (6) :851-865.
|
[19]TU C, JIANG BQ, ZHAO YL, et al.Comparison of processed and crude Polygoni Multiflori Radix induced rat liver injury and screening for sensitive indicators[J].Chin J Chin Mater Med, 2015, 40 (4) :654-660. (in Chinese) 涂灿, 蒋冰倩, 赵艳玲, 等.何首乌炮制前后对大鼠肝脏的损伤比较及敏感指标筛选[J].中国中药杂志, 2015, 40 (4) :654-660.
|
[20]CHEN M, SUZUKI A, BORLAK J, et al.Drug-induced liver injury:Interactions between drug properties and host factors[J].J Hepatol, 2015, 63 (2) :503-514.
|
[21]HUANG YS.Recent progress in genetic variation and risk of antituberculosis drug-induced liver injury[J].J Chin Med Assoc, 2014, 77 (4) :169-173.
|
[22]DAS S, BEHERA SK, XAVIER AS.Agreement among different scales for causality assessment in drug-induced liver injury[J].Clin Drug Investig, 2018, 38 (3) :211-218.
|
[23]PETROS Z, KISHIKAWA J, MAKONNEN E, et al.HLA-B*57allele is associated with concomitant anti-tuberculosis and antiretroviral drugs induced liver toxicity in Ethiopians[J].Front Pharmacol, 2017, 8:90.
|
[24]RACHI C, PIPALIYA N, PATEL R, et al.Drug induced liver injury at a tertiary hospital in India:Etiology, clinical features and predictors of mortality[J].Ann Hepatol, 2017, 16 (3) :442-450.
|
[25]MEDINA-CALIZ I, ROBLES-DIAZ M, GARCIA-MUOZ B, et al.Definition and risk factors for chronicity following acute idiosyncratic drug-induced liver injury[J].J Hepatol, 2016, 65 (3) :532-542.
|
[1] | Shimei WANG, Shuai JIN, Junru LI, Na WANG, Yan CHEN, Ying CUI, Mingming MA, Xiaoli HU. Influencing factors for the prognosis of patients with drug-induced liver injury and establishment of a nomogram model[J]. Journal of Clinical Hepatology, 2024, 40(3): 562-567. doi: 10.12449/JCH240320 |
[2] | Yu WU, Jinling DONG, Manman XU, Huina CHEN, Huaibin ZOU, Li BAI, Yu CHEN. Acute-on-chronic liver failure: Features and prognosis of a new clinical classification system based on onset manifestations[J]. Journal of Clinical Hepatology, 2023, 39(10): 2375-2382. doi: 10.3969/j.issn.1001-5256.2023.10.015 |
[3] | Fengxin CHEN, Zhan ZENG, Fangfang SUN, Leiping HU, Yao LU, Lu ZHANG, Minghui LI, XIE Yao. Clinical features and autoantibody characteristics of patients with drug-induced liver injury: An analysis of 419 cases[J]. Journal of Clinical Hepatology, 2022, 38(1): 148-153. doi: 10.3969/j.issn.1001-5256.2022.01.023 |
[4] | Yang Xue, Tu RongFang, Yang JinHui. Research advances in drug-induced liver injury[J]. Journal of Clinical Hepatology, 2020, 36(3): 509-513. doi: 10.3969/j.issn.1001-5256.2020.03.006 |
[5] | Feng YongHeng, Zheng ZeQun, Liu ShuangYue, Zhao YouCai, Yang KunXing, Xi PengCheng. Pathological typing and clinical features of Vater ampullary adenocarcinoma[J]. Journal of Clinical Hepatology, 2020, 36(5): 1104-1108. doi: 10.3969/j.issn.1001-5256.2020.05.030 |
[6] | Chen FeiFan, Chen CongYing, Zhang YaJing, Zhang YiYi, Huang YinShi, Xu Min. Clinical features of patients with pancreatic neuroendocrine tumor and influencing factors for prognosis[J]. Journal of Clinical Hepatology, 2020, 36(2): 399-403. doi: 10.3969/j.issn.1001-5256.2020.02.034 |
[7] | Ji TongTong, Lu HaiYing, Tan Ning, Yu YanYan, Xu XiaoYuan. A comparative analysis of the clinical features of acute and chronic drug-induced liver injury[J]. Journal of Clinical Hepatology, 2020, 36(7): 1556-1561. doi: 10.3969/j.issn.1001-5256.2020.07.021 |
[8] | Ye LiHong, Wang ChongKui, Shao Chen, Zhang HaiCong, Liu ZhiQuan, Wang TaiLing. Clinical and biochemical features of bile duct injury type of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2020, 36(5): 1059-1064. doi: 10.3969/j.issn.1001-5256.2020.05.022 |
[9] | Jing Jing, He TingTing, Wang RuiLin, Zhang Fan, Niu Ming, Guo YuMing, Zhu Yun, Xiao XiaoHe, Wang JiaBo. Detection of the risk signals of drug-induced liver injury: Challenges and advances[J]. Journal of Clinical Hepatology, 2020, 36(3): 491-496. doi: 10.3969/j.issn.1001-5256.2020.03.002 |
[10] | Xing Lu, Wang Yu, Tao YanYan, Liu ChengHai. Clinical evaluation and prognosis prediction of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2019, 35(12): 2820-2823. doi: 10.3969/j.issn.1001-5256.2019.12.039 |
[11] | Zhang YanFang, Guo YuMing, Niu Ming, Ge FeiLin, Jing Jing, Zhu Yun, Zhu ShiShu, Han ZiXin, Wang JiaBo, Liu ShiJing, Xiao XiaoHe. Drug-induced liver injury in children:An analysis of medication and clinical features[J]. Journal of Clinical Hepatology, 2019, 35(3): 579-584. doi: 10.3969/j.issn.1001-5256.2019.03.025 |
[12] | Ye LiHong, Wang ChongKui, Jin Peng, Zhao LiangLiang, Zhang HaiCong, Liu ZhiQuan, Tang YaFang. Clinicopathological features of drug-induced liver injury or primary biliary cholangitis with vanishing bile duct syndrome[J]. Journal of Clinical Hepatology, 2019, 35(2): 359-363. doi: 10.3969/j.issn.1001-5256.2019.02.023 |
[13] | Yu LeCheng, Fan Ye, Chen ChengWei. Diagnosis and treatment of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2018, 34(6): 1160-1165. doi: 10.3969/j.issn.1001-5256.2018.06.004 |
[14] | Zhang YanMei, Sun WenJing, Wen LiangZhi, Liu KaiJun, Wang Bin, Liu Hui, Chen DongFeng, Fu Xin. Clinical features of patients with drug-induced liver injury in China in the last five years[J]. Journal of Clinical Hepatology, 2018, 34(3): 562-566. doi: 10.3969/j.issn.1001-5256.2018.03.023 |
[15] | Guo XiaoDi, Sun ShaSha, Li WenDong, Shen YanJun, Sun Wei, Ding XiaoYan, Chen JingLong. Clinical features of patients with Barcelona Clinic Liver Cancer stage C primary liver cancer and related prognostic factors: An analysis of 140 cases[J]. Journal of Clinical Hepatology, 2018, 34(7): 1456-1461. doi: 10.3969/j.issn.1001-5256.2018.07.019 |
[16] | Yuan Ling, Yang YongGeng, Shen YouXiu, Ma YingCai. Research advances in drug- induced liver injury[J]. Journal of Clinical Hepatology, 2017, 33(2): 375-378. doi: 10.3969/j.issn.1001-5256.2017.02.038 |
[17] | Yang JunYang, Qi TangKai, Zhang RenFang, Liu Li, Shen YinZhong, Ji YongJia, Lu HongZhou. Clinical features and prognosis of AIDS complicated by drug-induced liver injury: an analysis of 119 cases[J]. Journal of Clinical Hepatology, 2017, 33(8): 1537-1542. doi: 10.3969/j.issn.1001-5256.2017.08.026 |
[18] | Ji ChenHua, Zhang ZhuQing, Wang XiaoYuan, Lu ShuMing. Clinical features of elderly patients with drug-induced liver injury[J]. Journal of Clinical Hepatology, 2017, 33(3): 502-506. doi: 10.3969/j.issn.1001-5256.2017.03.021 |
[19] | Liang Shan, Fan ZuoPeng, Nie Wei, Chou LiXia, Chen Jie, Lin Wei, Liu YiRong, Zhang Jing, Hu ZhongJie. Clinical types and features of chronicity of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2016, 32(12): 2356-2359. doi: 10.3969/j.issn.1001-5256.2016.12.025 |
[20] | Gan Yu, Dong Yi, Zhang HongFei, Xu ZhiQiang, Chen DaWei, Wang LiMin, Wang FuChuan, Yan JianGuo, Zhu ShiShu. Clinical characteristics and outcomes of drug-induced liver injury in children: a study of 184 cases[J]. Journal of Clinical Hepatology, 2015, 31(8): 1244-1247. doi: 10.3969/j.issn.1001-5256.2015.08.015 |