Abstract: Objective To analyze the clinical and pathological features of liver injury caused by Chinese and western medicine. Methods The general situation, clinical classification, medication history, laboratory indicators and pathological characteristics of liver puncture of in patients with drug-induced liver injury ( DILI ) admitted to our hospital from January 2015 to December 2020 were retrospectively analyzed. Results There were 102 patients with DILI, 27 males and 75 females, with an average age of (47±13) years. There were 187 patients with herb-induced liver injury ( HILI ), including 50 males and 137 females, with an average age of (49±11) years. There was no statistically significant difference between two groups in gender, age, body mass index (BMI), allergic history and drinking history. Both DILI and HILI were hepatocellular injury type, the numbers were 139 (74.3%) and 83 (81.4%), respectively. The levels of initial alkaline phosphatase (ALP) 171.0 (139.0, 242.0) U/L and total bilirubin (TBil) 96.6 (33.0, 209.9) umol/L of HILI group were higher than those of DILI group [initial ALP 150.0 (110.8, 246.8) U/L, initial TBil 73.9 (20.2, 148.3) umol/L], which was statistical significance (P<0.05). The levels of initial alanine aminotransferase (ALT) 895.0 (491.0, 1312.0) U/L and initial ALP 161.0 (125.0, 200.0) U/L of hepatocellular injury type in HILI group were higher than those in DILI group [initial ALT 541.0 (236.0, 1032.0) U/L, initial ALP 142.0 (107.0, 195.0) U/L], which was statistical significance (P<0.05). The levels of initial ALT 278.3±111.9 U/L, initial ALP 296.0 (202.0, 501.5) U/L, initial gamma-glutamyltransferase (GGT) 563.9±304.9 U/Land creatinine (Cr) 89.0 (64.5, 101.5) umol/Lof mixed injury type in DILI group were higher than those in HILI group [initial ALT 199.4±62.3 U/L, initial ALP 222.0 (167.5, 248.0) U/L, initial GGT 198.1±119.4 U/L, Cr 62.0 (54.0, 77.5) umol/L], which was statistical significance (P<0.05). In DILI group, the first suspected drugs inducing liver injury was antipyretic and analgesic, followed by drugs for thyroid diseases. Chinese medicines inducing HILI were mainly used in health care, skin disease, digestive system disease, bone and joint disease, etc. Compared to hepatocellular injury HILI, necrosis of liver cells, phagocytic pigment granules Kupffer cells, cholestasis in hepatocytes and / or the bile duct more likely occurred in hepatocellular injury DILI, which was statistical significance (P<0.05). Conclusion Hepatocyte injury is the main type of both DILI and HILI. Although the levels of initial ALT and ALP of DILI are lower than those of HILI, the pathological manifestations of liver injury is more severe in DILI.

Key words: Chinese herbal medicine, Western medicine, Liver injury, Clinical characteristics, Pathology, Integrated evidence chain