Abstract AIM: To analyze the clinical features of druginduced liver injury (DILI), and discuss the risk factors affecting its prognosis.

Transcription

1 : : DOI: /wcjd.v24.i ; 24(8): ISSN (print) ISSN (online) 2016 CLINICAL PRACTICE Multidisciplinary expert consensus on clinical features and prognosis of drug-induced liver injury Zhang-Qing Ren, Jin-Hai Wang, Hao Li, Yu-Ru Bai, Long-Bao Yang Zhang-Qing Ren, Jin-Hai Wang, Yu-Ru Bai, Long- Bao Yang, Department of Gastroenterology, the Second Affiliated Hospital of Xi an Jiaotong University, Xi an , Shaanxi Province, China Zhang-Qing Ren, Jin-Hai Wang, Yu-Ru Bai, Long- Bao Yang, Clinical Medical Research Center for Gastrointestinal Diseases in Shaanxi Province, Xi an , Shaanxi Province, China Hao Li, the Center for Disease Control and Prevention in Xi an, Xi an , Shaanxi Province, China Correspondence to: Jin-Hai Wang, Professor, Department of Gastroenterology, the Second Affiliated Hospital of Xi an Jiaotong University, 157 Xiwu Road, Xi an , Shaanxi Province, China. jinhaiwang@hotmail.com Received: Revised: Accepted: Published online: Abstract AIM: To analyze the clinical features of druginduced liver injury (DILI), and discuss the risk factors affecting its prognosis. METHODS: Clinical data for 572 patients with DILI hospitalized at the First Affiliated Hospital of Xi an Jiaotong University, the Second Affiliated Hospital of Xi an Jiaotong University and Xijing Hospital from 2010 to 2014 were retrospectively analyzed. Gender, age, underlying disease, medication time, clinical manifestation, clinical classification, type of drugs, laboratory tests, ways of medication, treatments and prognosis were analyzed to explore the risk factors affecting the prognosis. RESULTS: A total of 572 patients were involved, including 280 (48.95%) males and 292 (51.05%) females, and their average age was ± years. Most cases of DILI occurred in less than 8 weeks of medication. Main clinical manifestations were jaundice (59.44%), fatigue (57.52%), and poor appetite (55.54%). Four hundred and two (70.28%) cases were classified as hepatocellular type, 62 (10.84%) cases as cholestasis type and 53 (9.27%) as mixed type. The top three most common types of drugs that induced DILI were Chinese herbs, antituberculotics and antimicrobials., 1000, (drug-induced liver injury, DILI) 13%, 25%. DILI,.,, ;,, WCJD

2 DILI, 0.46%-1.08%, 10%-15%. DILI,,. As for the prognosis, 194 cases were cured, 323 cases improved well, 39 cases showed no significant improvement, and 16 cases died. Factors influencing prognosis of DILI were medication time, clinical classification, type of drugs and index of total bilirubin, with total bilirubin being an independent risk factor for DILI. CONCLUSION: Clinical manifestations of drug-induced liver injury are non-specific. The most common cause is Chinese medicine. There are many factors influencing DILI, with total bilirubin being the independent risk factor Baishideng Publishing Group Inc. All rights reserved. Key Words: Drug-induced liver injury; Clinical features; Prognostic analysis; Risk factors Ren ZQ, Wang JH, Li H, Bai YR, Yang LB. Multidisciplinary expert consensus on clinical features and prognosis of drug-induced liver injury. Shijie Huaren Xiaohua Zazhi 2016; 24(8): URL: com/ /24/1257.asp DOI: org/ /wcjd.v24.i (drug-induced liver injury, DILI), 5 572,,. (1) DILI 572, 280 (48.95%), 292 (51.05%), ; (2) 226, 205, 115, 155 ; <8 wk, 490 ; 59.44%, 57.52%, 55.42%; 402, 62, 53 ; DILI ; 533, 20, 14 ; 194, 323, 39, 16 ; (3). DILI.,,, DILI, 2016 (drug-induced liver injury, DILI), DILI 3 DILI. URL: asp DOI: (drug-induced liver injury, DILI),,.,,, 30000, DILI 1000, [1]., DILI 0.01%-0.15% [2],., 5572 DILI, DILI,,,, WCJD

3 / , 5 DILI. [3],,,,, 2 DILI, :,, (total bilirubin, TBIL) (direct bilirubin, DBIL) (alanine transaminase, ALT) (aspartate transaminase, AST) (total protein, TP) (alkaline phosphatase, ALP) (glutamyl transpeptidase, GGT) (prothrombin time, PT) PT%, DBIL ALT AST PT, : (CLOMS) 3 [4] : (1) : ALT>2, R 5(R = ALT ALP ); (2): ALP>2, R 2; (3) : ALT ALP>2 2<R<5. DILI : DILI 6 mo, : : (1) :, - ; (2) :,, 2 ; (3) :,, ; (4) : Excel, SPSS20.0, mean SD, t, ;, 2 Fisher, P <0.05. Logistic Logistic DILI 2, 161, 116, 295, (48.95%), 292 (51.05%), , 85, DILI : %, 23 ; , 32.52%; %, 251 ; 60112, 19.58% (39.51%); 205 (35.84%); 115 (20.10%), ( ) ; ( ) 155 (27.10%); 2.3 <8 wk, DILI 4-8 wk, 253, 44.23%; <4 wk, 237, 41.43%; >8 wk 66, 11.54%; 16 (2.80%) 46 (hepatitis B surface antigen, HBsAg) DILI, HBsAg DILD 46 WCJD

4 3 5 DILI,,,, 2.4 DILI 340 (59.44%) 329 (57.52%) 317 (55.42%), 209 (36.54%) 158 (27.62%) 99 (17.31%) 74 (12.94%) 71 (12.41%) 59 (10.31%) 106 (18.53%), , 402 (70.28%), 62 (10.84%), 53 (9.27%), 11 (1.92%) DILI, 44 (7.69%). 2.6 ( 17 ) [5],,,. DILI( 1)., DILI 5 7 DILI (93.18%), 20 (3.50%), 14 (2.45%), 2 (0.35%), 1 (0.17%), : TBIL: mol/l mol/l, DBIL: 113 mol/l mol/l, ALT: U/L U/L, AST: U/L U/L, ALP: U/L U/L, GGT: U/L U/L, TP: g/l 8.51 g/l, PT 122 (21.29%), 40.4 s, PT% 83 (14.46%), 20.4%. : TBIL: mol/l mol/l, ALT: U/L U/L, AST: U/L U/L, ALP: U/L U/L, PT 9 (1.57%) , 81 (14.16%). : (89.9%) (87.8%)(76.1%) (72.9%) (69.12%) (50.9%) (43.8%)(31.3%) (31.3%)(20.7%) (16.1%) (2.1%) (33.88%), 323 (56.48%), 39 (6.81%), 16 (2.83%). A,, B, 17, DILI, DILI (P <0.05)( 2, 3). Logistic ( 4), DILI(P <0.05),, WCJD

5 DILI, ( ) DILI DILI,. 2 DILI, 2 [6]. DILI DILI [7],, 3 mo,. ;,,, DILI, [8] [1]. DILI [9], DILI [10]., [11]. DILI 3, 52.27%., DILI,,. DILI. DILI : (1), 2 ; (2),,, ALT [12] ; (3) :, ALT ALP, [13]., DILI. ALF DILI,, WCJD

6 (DILI):,, DILI, [6]. CT MRI DILI. DILI, DILIN 300, <50% [14]. DILI, DILIN DILI [15].,, DILI, DILI : (1) :, ( ),,, ; (2) :,, ; (3) :, [16]. TBIL DILI [17].,, [18]. TBIL,, DILI. WCJD

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