关键词: 药物性肝损伤, 中草药及中成药, 肝损伤, 临床特征, 预后

Abstract: Objective To analyze the clinical characteristics and prognosis of patients with herb-induced liver injury (HILI) during acute liver injury. Methods A retrospective analysis was conducted on the clinical manifestations, laboratory results, progression to liver failure, and recovery status at discharge of 72 acute HILI patients with varying degrees of liver dysfunction during hospitalization in the Second Affiliated Hospital of Kunming Medical University. Results Among 72 patients with acute HILI, 30 with mild liver injury and 42 with moderate to severe injury, the sex distribution differed significantly between the two groups (male∶female 5∶25 vs. 19∶23, χ²=6.429, P=0.011). Patients in the moderate and above injury group had statistically significant differences compared with the mild injury group in AST(U/L)[631(360,1 049) vs. 263(158,460), U=14.629], ALT(U/L)[923(521,1 337) vs. 533(287,773),U=8.629],TBil(μmol/L)[118.5(83.1,238.9)vs.18.5(13.0,32.8), U=51.429], albumin(g/L)[37.35(33.2,41.4) vs. 40.9(36.6,43.1), U=8.229], PTA(%)[88.9(75.3,109.0) vs. 109.2(86.4,118.9), U=4.462]、INR[1.07(0.98,1.17) vs. 0.95(0.90,1.03), U=13.155]and plasma ammonia levels(μmol/L)[52(33,76) vs. 17(11,27), U=25.621] (P<0.05). Secondly, there was no significant difference in underlying diseases, medication route, and duration among patients with different degrees of liver injury. ALBI showed differences in evaluating patients with varying degrees of liver injury(χ²=19.061, P<0.001), with an AUC value of 0.820 for predicting progression to SALF (95%CI:0.718~0.922,P<0.001). There was no death among 72 patients with acute HILI, and 9 patients progressed to SALF. At discharge, all patients with acute HILI showed improvement in clinical symptoms and significant recovery in liver function. Conclusion Among patients with acute HILI, middle-aged women are more common, and the distribution of female patients is more similar between different degrees of injury, while moderate to severe injuries are more common in male patients. Moreover, there was no significant correlation between underlying diseases and the severity of liver function impairment in patients. The ALBI score has some clinical utility in assessing liver function status in patients with acute HILI and in predicting the risk of progression to SALF. For HILI patients, the short-term prognosis is usually optimistic.

Key words: Drug-induced liver injury, Chinese herbal medicine and Chinese patent medicine, Liver injury, Clinical characteristics, Pathology, Prognosis