ABSTRACT
Objective To analyze the clinical characteristics of drug-induced liver injury (DILI) from Chinese literatures published in Chinese Periodical Full-text Database (CNKI) from 2007 to 2011.Methods Using drug-induced liver injury as key words,the literatures in CNKI were searched,and the data of age,gender,medication,clinical manifestation and prognosis were analyzed.Results In search of CNKI,281 literatures were collected; finally 111 relevant papers were obtained.Total 10 693 cases of DILI were included with a male/female ratio of 1.14:1 and a mean age of 45.6 y ranging from 7 months to 93 y.Among 1093 cases with the age grouped,the highest incidence of DILI was in age 41-60 y(38.52％)and 20.68％ patients were over 60 y.Among 6592 cases with clinical manifestation recorded,43.51％ patients were asymptomatic and abnormal liver function was detected in health check-up; and others presented nonspecific gastrointestinal symptoms,including fatigue,nausea,vomiting and jaundice.In 9340 cases with medication recorded,the 6 most common drugs inducing DILI were antituberculotics (32.74％),Chinese herbs(22.12％),antibiotics(9.18％),antineoplastics(6.34％),NSAIDs (4.80％)and antithyroid drugs (4.37％).The most common type of toxicity was hepatocellular injury (63.66％,4438/6971).In general the prognosis was good with a fatality rate of 1.67％.Conclusions Antituberculotics and Chinese herbs are the main causes of DILI.Some DILI patients have occult onset and others have nonspecific gastrointestinal symptoms.Most patients have good prognosis if they are treated timely.
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Objective To compare the consistency of 2 methods,RUCAM and CDS,for assessment of drug-induced liver injury and their sensitivity and specificity.Methods A total of 332 patients with drug-induced liver disease,who admitted to the first hospital of Zhejiang university from January 2000 to December 2006,were retrospectively evaluated.The data were collected from patients including clinical presentation,liver function,etc.The liver function and the outcome of the patients after treatment were also observed.The probability of the diagnosis was classified as definitive,probable,possible,unlikely,or excluded.The consistency,the specificity and sensitivity of two methos were evaluated with Spearman correlation analysis.Results Absolute agreement between the 2 scales was observed in 91 cases(27.41%),with disagreement of 1 level in 219 cases(65.96%),and of 2 levels in 22 cases(6.63%),which showed a positive correlateion(r=0.485,P=0.001).Absolute agreement between the 2 scales was observed in 12 cases of severe drug-induced liver disease(18.46%)(r=0.578,P=0.001)and in 79 cases of minor drug-induced liver disease(29.59%)(r=0.382,P=0.001).The specificity of CDS was 100%,and the sensitivity was 57%and 25%in diagnosis of severe and minor drug-induced liver disease,respectively.Conclusions The best correlation between the 2 scales was obtained for drug-induced liver injury.The RUCAM scale showed better sensitivity,especially in diagnosis of server drug-induced liver disease.
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Objective To study problems related to drug-induced liver lesion caused by antituberculotic therapy (DLL).Methods Totally, 172 cases of DLL occurred in 1 464 patients with pulmonary tuberculosis after antituberculotic therapy, hospitalized during January 1995 to December 2002, were reviewed and analyzed retrospectively.Results Patients aged 20 to 60 years with DLL by antituberculolis therapy accounted for 70.3% of the total. Symptoms of digestive tract and change in liver function usually occurred within 8 weeks of intensive treatment (73.8%), and discontinuation of autituberculotic drugs was not needed for the mild cases, but needed for the severe cases with liver protective therapy. In total, 157 of the 172 cases (91.3%) recovered completely and 13 case improved (7.6%), two cases deteriorated and discharged, and doses of autituberculotic drugs should be reduced or stopped in 41 cases (23.8%) affecting their treatment efficacy.Conclusions DLL was liable to occur in patients of pulmonary tuberculosis with antituberculotic therapy, especially in the elderly men with body weight less than 50 kilograms, those with previous liver damage or infected with hepatotropic virus, alcohol drinking, complicated with extrapulmonary tuberculosis, with combination of isoniazid rifampicin and pyrazinamide.