title: [Clinical and pathological features in 138 cases of drug-induced liver injury].
abstract: OBJECTIVE
  To explore the categories of drugs causing hepatotoxicity and analyze the clinical and histological features of the corresponding drug-induced liver injury (DILI), in order to gain insights into potential diagnostic factors for DILI.
  
  
  METHODS
  A total of 138 DILI patients treated at our hospital from April 2008 to April 2010 were retrospectively analyzed. The responsible drug for each DILI case was recorded. The Roussel Uclaf Causality Assessment Method (RUCAM) had been used to diagnose DILI. Only cases that had scored as highly probable or probable (more than or equal to 6 points by RUCAM) were included in this study. The patients' general condition, clinical manifestations, and serum biochemical and immunological parameters were assessed. Sixty-six of the patients underwent liver biopsy, and were assessed for liver pathological changes. Clinical and laboratory test data were collected and used to classify the total 138 cases as hepatocellular injury, cholestatic, or mixed hepatocellular-cholestatic types.
  
  
  RESULTS
  Within our patient population, the leading cause of DILI was Chinese herb medicine, accounting for 53.62% of cases. Antibiotics were implicated in 7.97% of cases, and dietary supplement in 6.52% of cases. Correlation between the clinical features and histological injury pattern was stronger at the time of biopsy (more than or equal to 3 days after laboratory results) (kappa = 0.63, P less than 0.05) than at the onset of DILI (kappa = 0.25, P less than 0.05). All modified hepatic activity index (HAI) necroinflammatory scores and fibrosis scores were more severe in the cholestatic and mixed injury types than in the hepatocellular injury type (P less than 0.01 and P less than 0.05, respectively).
  
  
  CONCLUSIONS
  Chinese herbal medicine, dietary supplements and antibiotics were the main causes of DILI in our patient population. The clinical and histological features correlated well, especially at later stages of DILI. The degree of inflammation and fibrosis was significantly higher in cholestatic and mixed hepatocellular-cholestatic injury types than in the hepatocellular injury type. Assessment of both clinical and pathological features may represent a more accurate diagnostic method for DILI.
authors.affiliation: Department of Infection, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Rong-tao
authors.initials: RT
authors.lastname: Lai
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Hong-lian
authors.initials: HL
authors.lastname: Gui
authors.forename: Min-zhen
authors.initials: MZ
authors.lastname: Ye
authors.forename: Wei-jia
authors.initials: WJ
authors.lastname: Dai
authors.forename: Xiao-gang
authors.initials: XG
authors.lastname: Xiang
authors.forename: Gang-de
authors.initials: GD
authors.lastname: Zhao
authors.forename: Wei-jing
authors.initials: WJ
authors.lastname: Wang
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D004365:Drugs, Chinese Herbal