Objective To analyze the clinical data and outcomes of recurrent drug-induced liver injury(DILI)by different drugs.Methods A total of 93 patients with recurrent DILI who were admitted to our hospital and diagnosed twice or more from January 2015 to December 2022 were collected and statistically analyzed by T-test,Wilcoxon rank sum test,and Chi-squared Test method.Baseline characteristics of DILI,types of liver injury drugs and related underlying diseases,test results,liver pathology results,hormone therapy,and clinical outcomes were compared.Results The majority of 93 patients with recurrent DILI were female,and the average interval between recurrent DILI was 25.5 months.Grade 1 liver injury and hepatocyte injury were predominant in patients with recurrent DILI.The incubation time of the second DILI was 26.7 months,which was significantly shorter than that of the first DILI(38.4 months),and had statistical significance(P<0.05).In the recurrent DILI cases,Traditional Chinese medicine was the main drug used alone(51.61%VS.36.56%),and TCM combined with antipyretic and analgesic drugs and dietary supplements were the main drugs used in combination(5.38%VS.3.23%).TCM was mainly used for orthopedic purposes,followed by health purposes.TBIL,DBIL,ALP,GGT,TBA,TG,and AFP in the first DILI were higher than those in the second DILI,the Z values were respectively-4.835,-4.640,-2.699,-2.861,-2.871,-3.667,-3.311,with significant statistical significance(P<0.01).In the course of recurrent DILI,52.63%of patients'liver perforation pathology indicated that the fibrosis score was less than 2 points.Among them,two patients were diagnosed with simple DILI after two liver perforations,and fibrosis the second time was lighter than that of the first time.There were 8 cases(20.05%)with AIH-like DILI or advanced AIH,and the degree of inflammation and fibrosis score were both≥2.Twenty patients(21.5%)were treated with a short course of low-dose hormone therapy during recurrent DILI.There was no significant difference in the results of liver fibrosis and instantaneous elastic imaging color ultrasound compared to recurrent DILI(P>0.05).Conclusion Mild hepatitis was predominant in 93 patients with recurrent DILI,and most outcomes were good.However,it remains to be warned that some patients'continuous and chronic exposure to hepato-damaging drugs,especially Chinese herbal medicines with relatively complex components,may induce autoimmunity like DILI or AIH.
Recurrent drug-induced liver injuryTraditional Chinese medicineClinical characteristicsLiver histopathologyOutcome analysis
万方数据
维普
