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Background Drug-induced liver injury is the third major liver disease, following viral hepatitis and fatty liver disease. Timely diagnosis and effective treatment are crucial in halting disease progression and improving cure rates. Kuhuang preparation has been widely used in treating acute and chronic hepatitis stemming from various causes, particularly in patients manifesting jaundice, demonstrating clear clinical efficacy and safety. Nonetheless, there remains a dearth of evidence-based medical data concerning the efficacy and safety of hepatoprotective measures in patients with acute drug-induced liver injury. Objective To evaluate the efficacy and safety of Kuhuang injection sequential Kuhuang granules in the treatment of drug-induced liver injury. Methods Using a randomized, positive-controlled, non-inferiority trial design, 93 patients diagnosed with acute drug-induced liver injury at Beijing Youan Hospital, Capital Medical University, between November 2021 and September 2023 were selected. These patients were allocated through single-center randomization, with 49 cases assigned to the experimental group and 44 cases to the control group. After receiving conventional hepatoprotective therapy for 4 weeks, the experimental group and the control group were treated with Kuhuang injection/ adenosylmethionine butanedisulfonate for injection for 2 weeks, followed by Kuhuang granules/enteric-coated tablets of adenosylmethionine butanedisulfonate for another 2 weeks. The efficacy rates of jaundice regression, as well as changes in key liver function parameters [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin (TBIL), total bile acid (TBA) ] at baseline, 2 weeks, and 4 weeks of treatment, along with their normalization rates, were compared between the two groups. Results A total of 4 patients fell off during treatment, including 3 patients in the experimental group and 1 patient in the control group. Following 2 and 4 weeks of treatment, there was no significant difference observed in the efficient rate of jaundice regression between the two groups (P>0.05). Similarly, no significant differences were detected in the levels of ALT, AST, ALP, GGT, TBIL, and TBA between the two groups at the 2-week and 4-week marks of treatment (P>0.05). Additionally, there were no notable variations in the recurrence rates of ALT, AST, ALP, GGT, TBIL, and TBA between the two groups following 2 and 4 weeks of treatment (P>0.05) . Conclusion Kuhuang Injection Sequential Kuhuang Granules has definite efficacy and good safety in the treatment of drug-induced liver injury, and is not inferior to adenosylmethionine butyldisulfonate for injection sequential enteric-coated tablets of adenosylmethionine butanedisulfonate.

In recent years, an increasing number of reports have been made on drug-induced liver injury (DILI ) caused by Chinese materia medica, which has negatively influenced the development of traditional Chinese medicine (TCM). This article aims to analyze the current literature database on DILI reports related to Chinese materia medica, highlight the problems and deficiencies in the process of reporting DILI by Chinese materia medica, and suggest recommendations for a rational reporting procedure for this complication. Research findings indicated that published studies on DILI by Chinese materia medica contain incomplete information on Chinese materia medica sources, an absence of analysis of concurrent medication, alcohol consumption, and use of dietary supplements, and a clear violation of the basic principles of adverse drug reaction (ADR) reporting, leading to excessive reporting of DILI by Chinese materia medica. Additionally, to clarify the causative drugs, this article proposes the definition of Chinese materia medica-related DILI, and suggests a standardized reporting procedure for Chinese materia medica-related DILI. This article clarifies the true etiology of DILI and by referring to both domestic and international standards for handling ADR reporting, establishes standardized procedures for reporting Chinese materia medica-related DILI. These efforts are intended to further optimize the clinical application of Chinese materia medica and promote the healthy development of the TCM. [ABSTRACT FROM AUTHOR]

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Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the clinical features and autoantibody characteristics of patients with drug-induced liver injury (DILI). Methods A retrospective analysis was performed for the patients with abnormal liver function who were admitted to Beijing Ditan Hospital, Capital Medical University, from September 2014 to September 2018 and were diagnosed with DILI based on RUCAM score, and related data on admission were collected, including baseline liver function, renal function, routine blood test results, five immune indices, autoantibody, and liver biopsy results. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used to compare the detection rate of autoantibody between the patients with different sexes or types of liver injury. A logistic regression analysis was used to investigate whether autoantibody had a regression relationship with sex, age, and type of injury, and an ordinal logistic regression analysis was performed with baseline laboratory results as independent variables and anti-nuclear antibody (ANA) titer as the dependent variable. Results A total of 419 patients with DILI were enrolled in the study, with a median age of 47 (35-55) years, among whom male patients accounted for 32.5% (136/419) and female patients accounted for 67.5% (283/419). Among these 419 patients, 88 (21.5%) had hepatocellular-type liver injury, 87 (21.2%) had mixed-type liver injury, and 235 (57.3%) had cholestasis-type liver injury. The detection rate of autoantibodies was 50.6% (212/419), and the detection rate of ANA was 42.9% (180/419), with a titer of mainly 1∶ 100 (104/180). There was no significant difference in the detection rate of autoantibodies between the patients with different sexes (χ2=2.658, P=0.103) or different types of injury (χ²=0.859, P=0.651). The binary logistic regression analysis showed that autoantibody did not have a regression relationship with sex, age, and type of injury (all P > 0.05) There were significant differences in prothrombin time activity (PTA) and international normalized ratio (INR) between the positive autoantibody group and the negative autoantibody group (t=2.161, P=0.031; Z=-3.010, P=0.003). The ordinal logistic regression analysis showed that INR (odds ratio [OR]=3.101, P=0.040) and IgG (OR=1.043, P=0.014) were associated with ANA grade. Conclusion There is a relatively high detection rate of autoantibodies in patients with DILI, and the detection rate of autoantibodies is not associated with sex, age, or type of injury. There are differences in PTA and INR between autoantibody-positive patients and autoantibody-negative patients, and the levels of INR and IgG are correlated with antibody titer. [ABSTRACT FROM AUTHOR]

To investigate the role of multi-disciplinary team (MDT) in the treatment of complex cholestatic liver injury after liver transplantation. Methods MDT consultation was conducted to clarify the causes and therapeutic strategies for one case of complex cholestatic liver injury after liver transplantation admitted to Liver Transplantation Center of the First Hospital of Jilin University on June 23, 2020. And the role of MDT in the treatment of complex cholestatic liver injury after liver transplantation was summarized. Results The patient presented with abnormal liver function after liver transplantation. The diagnosis of biliary stricture, rejection and biliary tract infection was confirmed successively. Endoscopic retrograde cholangiopancreatography (ERCP) stent internal and external double drainage, glucocorticoid shock and anti-infection therapy yielded low clinical efficacy. After MDT consultation, complex cholestatic liver injury after liver transplantation was confirmed. It was suggested to optimize the immunosuppressive regimen based on the exclusion of rejections by pathological examination, deliver targeted anti-infection interventions and prevent the potential risk of concomitant drug-induced liver injury. The patient was discharged after proper recovery. Conclusions The causes of complex cholestatic liver injury after liver transplantation are diverse, and the condition changes dynamically. MDT consultation are performed to deepen the understanding of this disease, strengthen the classification of diagnosis and treatment ideas and enhance the precision and efficacy of corresponding treatment. [ABSTRACT FROM AUTHOR]

Objective To explore the role of clinical pharmacists in rational drug use through the pharmacy care of an elderly pneumonia patient with Chlamydia psittaci infection and drug-induced liver injury. Methods The clinical pharmacists participated in the treatment of one patient with Chlamydia psittaci pneumonia and drug-induced liver injury. Based on the results of second-generation gene sequencing, the characteristics of the pathogen were learned by literature search. The clinical pharmacists monitored the patient ’s liver and kidney function, provided a new medication treatment plan to Doctors, and performed patient education during the treatment. Results The initial empirical anti-infective treatment with teicoplanin and imipenem-cilastatin was not effective. After the diagnosis of Chlamydia psittaci and Candida albicans infection, the combination of doxycycline with azithromycin and fluconazole was administered. Drug-induced liver injury was found with this treatment. The clinical pharmacist proposed to switch to doxycycline and clarithromycin with co-administration of magnesium isoglycyrrhizinate and polyene phosphatidylcholine to protect the liver. With this new regime, patient's liver function was improved and the infection was under control. Conclusion Individualized pharmaceutical cares provided by clinical pharmacists helped the safe, rational and effective use of medications. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: To systematically evaluate the efficacy and safety of magnesium isoglycyrrhizinate in the prevention of liver injury induced by chemotherapy. METHODS: CNKI, Wanfang database, VIP database, PubMed and the Coehrane library were retrieved to collect the randomized controlled trial ( RCT ) of magnesium isoglycyrrhizinate in the prevention of liver injury induced by chemotherapy [the study group was given magnesium isoglycyrrhizinate injection, while the control group received other kinds of hepatoprotective drugs ( tiopronin, glutathione, diammonium glycyrrhizinate); outcome indicators included the incidence of abnormal liver function, the levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TBIL) and the incidence of adverse drug reactions]. Cochrane Bias Risk Assessment Scale was used to evaluate the methodological quality of the included literature. RevMan 5. 3 software was used for Meta-analysis. RESULTS: Totally 13 literature were extracted, including 1 418 patients. Meta-analysis showed that the incidence of abnormal liver function (RR = 0. 44,95%CI = 0. 33-0. 59,P<0. 000 01), levels of ALT (MD = -10. 81,95%CI = -14. 20--7. 43,P <0. 000 01), ALP (MD = -15. 56,95%CI =-20. 78--10. 34,P<0. 000 01) and TBIL (MD =-4. 00,95%CI =-5. 24--2. 77,P<0. 000 01) in the study group were significantly lower than those in the control group, and the differences were statistically significant. There was no significant difference in the incidence of adverse drug reactions between the study group and the control group (RR = 0. 72,95%CI = 0. 37-1. 38,P = 0. 32). CONCLUSIONS: The effects of prophylactic use of magnesium isoglycyrrhizinate in reducing the incidence of abnormal liver function induced by chemotherapy and improving levels of ALT, ALP, TBIL is better than that of other liver protective drugs, and does not increase the incidence of adverse drug reactions, which has clinical application value. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To summarize the incidence, diagnostic and therapeutic experience of hepatic sinusoidal obstruction syndrome (HSOS) after liver transplantation. Methods Clinical data of 4 patients with HSOS after liver transplantation were retrospectively analyzed. The incidence, clinical manifestations, imaging and pathological characteristics of HSOS after liver transplantation were collected, and the treatment methods and clinical outcomes of patients with HSOS were analyzed. Results The incidence of HSOS after liver transplantation was 0.8%(2/239), and the median time of onset was 4.5(1.7, 9.0) months after liver transplantation. The clinical manifestations of HSOS mainly included abdominal distension, ascites, hepatomegaly, increased bilirubin, and renal insufficiency in partial cases. Enhanced abdominal CT scan of 4 patients with HSOS showed uneven spot-like enhancement and the liver histopathological examination mainly showed the signs of hepatic sinusoidal dilatation complicated with congestion. Four patients were administered with an adjusted regime of immunosuppressant by replacing tacrolimus (Tac) with ciclosporin and adding anticoagulant therapy with warfarin. One patient received transjugular intrahepatic portosystemic shunt (TIPS). After treatment, the symptoms of 3 patients were completely relieved, and 1 patient died. One of the 3 surviving patients died from pulmonary infection and gastrointestinal bleeding. Conclusions HSOS is a rare and fatal complication after liver transplantation. Timely diagnosis and treatment can avoid the incidence of graft failure and improve clinical prognosis of the patients. [ABSTRACT FROM AUTHOR]

Drug can cause almost all known types of acute, subacute, and chronic liver injuries. Drug-induced liver injury (DILI) is an important cause of unexplained liver injury in clinical practice. Correct diagnosis of DILI is challenging due to lack of specific diagnostic biomarkers, especially in patients with pre-existing liver disease and multiple concomitant drugs. A comprehensive understanding of the risk factors, clinical features, and prognosis of liver injury caused by different drugs will help physicians to recognize, diagnose, and manage it timely. Although the guideline was developed based on evidence-based medicine provided by the latest studies, there is limited high-quality evidence in the field of DILI. Therefore, this guideline should be interpreted with caution, and physicians should adopt an optimal diagnostic and therapeutic strategy for individual patients within the framework of the guideline.

Objective: To explore the drugs and clinical characteristics causing drug-induced liver injury (DILI) in recent years, as well as identify drug-induced liver failure, and chronic DILI risk factors, in order to better manage them timely. Methods: A retrospective investigation and analysis was conducted on 224 cases diagnosed with DILI and followed up for at least six months between January 2018 and December 2020. Univariate and multivariate logistic regression analyses were used to identify risk factors for drug-induced liver failure and chronic DILI. Results: Traditional Chinese medicine (accounting for 62.5%), herbal medicine (accounting for 84.3% of traditional Chinese medicine), and some Chinese patent medicines were the main causes of DILI found in this study. Severe and chronic DILI was associated with cholestatic type. Preexisting gallbladder disease, initial total bilirubin, initial prothrombin time, and initial antinuclear antibody titer were independent risk factors for DILI. Prolonged time interval between alkaline phosphatase (ALP) and alanine aminotransferase (ALT) falling from the peak to half of the peak (T(0.5ALP) and T(0.5ALT)) was an independent risk factor for chronic DILI [area under the receiver operating characteristic curve (AUC) = 0.787, 95%CI: 0.697~0.878, P  < 0.001], with cutoff values of 12.5d and 9.5d, respectively. Conclusion: Traditional Chinese medicine is the main contributing cause of DILI. The occurrence risk of severe DILI is related to preexisting gallbladder disease, initial total bilirubin, prothrombin time, and antinuclear antibodies. T(0.5ALP) and T(0.5ALT) can be used as indicators to predict chronic DILI.

Objective To investigate the pathological and biochemical features of each pathological subtype of bile duct injury type of drug-induced liver injury(DILI), and to verify the value and significance of pathological classification of DILI. Methods A retrospective analysis was performed for the clinical data of 112 patients with bile duct injury type of DILI who were admitted to Shijiazhuang Fifth Hospital from January 2006 to January 2016 and China-Japan Friendship Hospital from October 2003 to June 2014. According to the pathological subtype, the patients were divided into mixed hepatitis group with 40 patients, cholestatic hepatitis group with 40 patients, and simple cholestasis group with 32 patients, and the three groups were compared in terms of types of drugs used, course of disease, R value, and peak values,changing trend, time to peak, and recovery time of liver biochemical indices. The independent-samples Kruskal-WallisHtest was used for comparison of continuous data between multiple groups, and the Mann-WhitneyUtest was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups.Results Among the drugs inducing DILI, traditional Chinese medicine and Western medicine each accounted for half of the cases of bile duct injury type of DILI. Traditional Chinese medicine mainly included the drugs for osteoarthropathy, intervertebral disc bulge, alopecia, calculus-removing and cholagogic treatment,Yang-tonifying therapy, and skin diseases; 26 patients(65%) in the cholestatic hepatitis group had DILI caused by traditional Chinese medicine, while 16 patients(40%) in the mixed hepatitis group and 13(40.6%) in the simple cholestasis group had such DILI. Antibiotics and antipyretic and analgesic drugs were the most common Western medicines for DILI. The mixed hepatitis group had the highest peak values of ALT and AST and R value, followed by the cholestatic hepatitis group and the simple hepatitis group (χ2 =54.77, 44.21, and5195, allP<0.001), and there were no significant differences in the peak values of the other liver biochemical parameters between the three groups(allP>0.05). In the mixed hepatitis group and the cholestatic hepatitis group, the time to peak of TBil was longer than that of ALT. There were no significant differences in course of disease, time to peak of liver biochemical parameters, and recovery time between the three groups(allP>0.05).Conclusion Each subtype of bile duct injury type of DILI has unique clinical and biochemical features,and an understanding of such features may help to accurately judge clinical typing, pathological changes of targets, and degree of injury. [ABSTRACT FROM AUTHOR]

Objective To systematically review the clinical of artificial liver support system (ALSS) in the treatment of drug-induced liver failure. Methods PubMed, Embase, The Cochrane Library, CMB, CNKI, and VIP databases were searched for related randomized controlled trials or randomized controlled trials on ALSS in the treatment of drug-induced liver failure published up to October 2019, and a statistical analysis was performed. Odds ratio (OR) was the effect size for categorical data, and the difference between groups was the effect size for continuous data. The weighted mean difference (WMD) method was used for the pooled analysis of effect size, and 95% confidence interval (CI) was calculated for each effect size. I2 and P values were used to evaluate the heterogeneity of the articles included in the analysis; a fixed effect model was used when I2＜50% and P＞0.1, otherwise a random effects model was used. Results A total of 16 articles with 945 patients were included, with 520 patients in the ALSS+routine medical treatment (RMT) group and 425 in the RMT group. The meta-analysis showed that compared with the RMT group, the ALSS+RMT group had a significantly lower mortality rate of drug-induced liver failure (OR=0.27, 95%CI: 0.20-0.36, P＜0.001), significant improvements in albumin (Alb) (MD=1.21, 95%CI: 0.18-2.25, P=0.02) and prothrombin activity (PTA) (MD=11.84, 95%CI: 6.34-17.35, P＜0.001), and a significant reduction in total bilirubin (TBil) (MD=-104.97, 95%CI: -163.63 to -46.30, P＜0.001). Further analysis of Alb, TBil, and PTA after the withdrawal of ALSS showed that ALSS significantly improved Alb (MD=1.74, 95%CI: 1.20-2.27, P＜0.001) and PTA (MD=4.45, 95%CI: 2.80-6.10, P＜0.001) and significantly reduced TBil (MD=-128.41, 95%CI: -217.22 to -39.59, P=0.005). Conclusion Compared with RMT alone, RMT combined with ALSS can significantly improve the main biochemical indicators of patients with drug-induced liver failure and reduce their mortality rate. [ABSTRACT FROM AUTHOR]

Although drug-induced liver injury( DILI) is often an acute process,about 20% of the patients may progress to chronic DILI.Chronic DILI has a long course of disease and there is still no effective treatment. With the development and clinical application of new drugs and the wide application of herbal and dietary supplements,the incidence rate of DILI chronicity gradually increases. This article overviews the latest research advances in DILI chronicity from the aspects of the epidemiology,risk factors,clinical manifestations,diagnosis,and treatment of DILI,so as to gain a comprehensive understanding of chronic DILI. [ABSTRACT FROM AUTHOR]

Drug-induced liver injury( DILI) with extrahepatic adverse drug reaction( EHADR) is the injury of extrahepatic organs which is caused by the same drug inducing liver injury and may occur simultaneously or successively with DILI,such as the skin,gastrointestinal tract,blood system,cardiovascular system,and bone and joint system,and it should be taken seriously in clinical practice. DILI with EHADR is not rare,and its pathogenesis may be associated with various factors including the physicochemical properties,distribution,metabolism,excretion,biological activity,and immunological properties of drugs,host genetic background,and underlying diseases. The diagnosis and treatment of DILI with EHADR is more challenging than that of DILI alone. [ABSTRACT FROM AUTHOR]

Early detection and effective monitoring of the risk signals of drug-induced liver injury( DILI) are of great importance in the prevention and management of DILI in clinical practice. However,the lack of high sensitivity and strong specificity in the detection of risk signals brings great challenges to the identification and monitoring of risk signals and causes difficulties in establishing the strategies for the prevention and control of DILI. This article analyzes the challenges in the identification of DILI risk signals,summarizes the applicability and limitations of risk signals based on commonly used indices in early recognition,prediction,and early warning of DILI,proposes an identification and monitoring model for DILI risk signals based on specific biomarkers,and elaborates on their potential clinical values,so as to provide a scientific basis for developing targeted strategies for the prevention and control of the risk of DILI. [ABSTRACT FROM AUTHOR]

Objective To compare the liver histopathological features of drug-induced liver injury( DILI) caused by Chinese herbal medicine( HM) and that caused by Western medicine( WM),and to investigate the pathological features of HM-DILI. Methods A total of50 patients with drug-induced liver injury( DILI) who were diagnosed and treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from March 2014 to June 2019. All the patients with DILI were enrolled and divided into HM-DILI group and WM-DILI group. A retrospective analysis was performed for the clinical features and the pathological features of the two groups,including the clinical type of DILI,severity of liver injury,and liver histopathological features,especially location and grade of liver inflammation,type and degree of steatosis,and iron deposition. The t test and Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; the Mann-Whitney U test was used for comparison of ranked data. Results Of all 50 patients,20( 40. 0%) had HM-DILI and 30( 60%) had WM-DILI. There were no significant differences in sex,age,course of disease,and biochemical parameters of liver function between the two groups( all P > 0. 05). The main clinical types of the two groups were hepatocellular injury type and the degree of injury which was mainly grade l,and there were no significant differences in the clinical type of DILI and the severity of liver injury between the two groups( both P > 0. 05). As for liver histopathological features,both groups had varying degrees of focal necrosis of hepatocytes,steatosis( microvesicular,macrovesicular,and mixed),and fibrous tissue proliferation at the portal area,and compared with the WM-DILI group,the HM-DILI group had significantly greater lymphocyte/plasma cell infiltration in the portal area( χ2= 3. 860,P < 0. 05) and iron deposition in Kupffer cells( χ2= 4. 787,P < 0. 05).Conclusion There are no significant differences in clinical manifestations between HM-DILI and WM-DILI,but patients with HM-DILI have more obvious inflammation in the portal area and iron deposition in Kupffer cells than those with WM-DILI. [ABSTRACT FROM AUTHOR]

Drug-induced liver injury (DILI) has a complex pathogenesis and obvious individual difference. Early diagnosis and treatment of DILI may achieve good prognosis, but due to a lack of specific clinical symptoms, most cases cannot be identified in the early stage. If no timely treatment is given, DILI may progress to irreversible liver failure with a high mortality rate, and there are no effective therapies for advanced DILI except liver transplantation. Therefore, early diagnosis and treatment are of great importance for patients with DILI. This article summarizes the recent research advances in DILI, including suspected drugs, risk factors, pathogenesis, pathological features, clinical types and manifestations, diagnostic criteria and evaluation, and network database, in order to provide a basis for early diagnosis, clinical typing, treatment guidance, and prognostic evaluation of DILI. [ABSTRACT FROM AUTHOR]

Objective To investigate the protective effect of pinocembrin (PIN) in a mouse model of liver injury induced by acetaminophen (APAP). Methods A total of 50 healthy male C57BL/6J mice were randomly divided into blank group, PIN (50 mg/kg) group, APAP (300 mg/kg) model group, PIN (30 mg/kg)+APAP (300 mg/kg) experimental group, and PIN (50 mg/kg)+APAP (300 mg/kg) experimental group, with 10 mice in each group. The mice in the blank group and the model group were given an equal volume of normal saline by gavage, and those in the PIN group and the PIN+APAP groups were given PIN by gavage once a day, for 7 consecutive days. At 2 hours after the last administration, the mice in the model group and the PIN+APAP groups were given intraperitoneal injection of APAP 300 mg/kg once, and those in the blank group and the PIN group were given intraperitoneal injection of an equal volume of normal saline. Serum samples were collected to measure the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST); liver tissue homogenate was prepared to measure the biochemical parameters of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH); HE staining was used to observe liver histopathology. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results Compared with the blank group, the APAP (300 mg/kg) model group had significant increases in the activities of ALT and AST (P＜0.01), suggesting that a model was successfully established, while the PIN (30 mg/kg)+APAP (300 mg/kg) group and the PIN (50 mg/kg)+APAP (300 mg/kg) group had significant reductions in the levels of ALT and AST (P＜0.01). Compared with the blank group, the APAP (300 mg/kg) model group had a significant increase in the level of MDA and significant reductions in SOD activity and GSH level in the liver (P＜0.01); compared with the APAP (300 mg/kg) model group, the PIN (30 mg/kg)+APAP (300 mg/kg) group and the PIN (50 mg/kg)+APAP (300 mg/kg) group had a significant reduction in the level of MDA and significant increases in SOD activity and GSH level in the liver (P＜0.05). Histopathological observation showed that PIN significantly improved liver injury caused by APAP and helped to maintain normal liver histomorphology. Conclusion PIN exerts a marked protective effect on liver injury induced by APAP, possibly by inhibiting oxidative stress in the liver. [ABSTRACT FROM AUTHOR]

Objective To investigate the single nucleotide polymorphism( SNP) and serum expression of interferon-gamma-induced protein 10( IP-10) in patients with drug-induced liver injury accompanied by autoimmune phenomena( AI-DILI). Methods A total of 168 patients with drug-induced liver injury( DILI) who were diagnosed and treated in Beijing YouAn Hospital,Capital Medical University,from October 2016 to June 2019 were enrolled and divided into AI-DILI group( n = 72) and non-AI-DILI group( n = 96). The SNP of IP-10 rs56061981 locus was detected and the serum level of IP-10 was measured. The two groups were compared in terms of IP-10 level and SNP genotype,and their association with the development of AI-DILI was analyzed. Allele frequency was calculated based on genotype results,and the chi-square test was used for Hardy-Weinberg equilibrium analysis. The t-test and the Mann-Whitney U test were used for comparison between two groups; a repeated measures analysis of variance was used for comparison between different time points; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Pearson correlation analysis was used to investigate correlation. The receiver operating characteristic( ROC) curve was used to analyze the value of baseline IP-10 level in predicting AI-DILI. Results There was a significant difference in the positive rate of autoantibody between the AI-DILI group and the non-AI-DILI group( 91. 67% vs 12. 5%,χ2= 103. 8,P < 0. 05). Compared with the non-AI-DILI group,the AI-DILI group had significantly higher distribution frequency of CC genotype( 77. 78% vs 62. 50%,χ2= 4. 592,P = 0. 03) and frequency of C allele( 86. 11% vs 72. 92%,χ2= 4. 41,P = 0. 04). The AI-DILI group had a significantly higher baseline IL-10 level than the non-AI-DILI group( 627. 99 ± 198. 07 pg/ml vs 378. 13 ± 218. 45 pg/ml,t = 7. 34,P < 0. 05),and baseline IL-10 level was positively correlated with baseline aspartate aminotransferase level and AIH score( r = 0. 67 and 0. 79,both P < 0. 05). At the optimal cut-off value of 527. 03 pg/ml,baseline IP-10 level had a sensitivity of 0. 846,a specificity of 0. 867,and an area under the ROC curve of 0. 832 in predicting AI-DILI. CC genotype combined with a baseline IP-10 level of ≥527. 03 pg/ml had a positive predictive value of 92. 84% and a negative predictive value of 86. 33% in predicting the development of AI-DILI. Conclusion CC genotype of IP-10 rs56061981 is associated with the development of AI-DILI and affects the serum expression of IP-10,and the combination of CC genotype and IP-10 expression has a high value in predicting AI-DILI. [ABSTRACT FROM AUTHOR]

Objective To investigate the common etiology and clinical features of hepatomegaly of unknown origin. Methods A retrospective analysis was performed for the clinical data of 87 patients with hepatomegaly of unknown origin who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from January 2009 to December 2018, including sex, age, clinical symptoms, signs, and laboratory markers. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups and further comparison between two groups. For categorical variables, the chi-square test was used for comparison of categorical data between groups. Results Among the 87 patients, 2(2. 30%) had unknown etiology, and 85(97. 70%) had a confirmed diagnosis based on pathology, among whom 18(20. 69%) had non-hepatotropic viral hepatitis, 8(9. 20%) had chronic drug-induced liver injury, and 22(25. 29%) had glycogen storage disease. There were significant differences in age, sex, alanine aminotransferase, aspartate aminotransferase, white blood cell count, and platelet count between the non-hepatotropic viral hepatitis group, the chronic drug-induced liver injury group, and the glycogen storage disease group(χ2= 5. 80, 10. 34, 16. 85, 18. 69, 10. 02, 12. 76, all P < 0. 05). According to the results of pathological examination, the patients with glycogen storage disease had typical plant cell-like arrangement with positive results of PAS staining; the patients with chronic drug-induced liver injury had disordered lobular structure and mixed inflammatory cell infiltration with a majority of polymorphonuclear leukocytes in the hepatic sinusoids; the patients with non-hepatotropic viral hepatitis mainly had liver parenchymal inflammation, disordered lobular structure, and pseudolobular structure in the early stage. Conclusion Hepatomegaly of unknown origin has complex etiologies, with inherited metabolic diseases as the most common cause, mainly glycogen storage diseases. Other causes such as non-hepatotropic viral hepatitis and chronic drug-induced liver injury arealso important causes of hepatomegaly of unknown origin. [ABSTRACT FROM AUTHOR]

Primary hepatocellular carcinoma has a high degree of malignancy, insidious onset, and rapid progression that seriously threatens human life and health. With the continuous deepening of the study of the molecular characteristics of tumors, molecular targeted drugs have become an important treatment method for patients with advanced liver cancer. Liver injury is one of the common adverse reactions of targeted drugs, which needs to be paid attention to. This paper mainly briefly expounds on the occurrence condition, mechanism, risk factors, diagnosis, and treatment of liver injury caused by hepatocellular carcinoma targeted therapy in order to provide a reference for the safe clinical application of targeted drugs.

Objective To evaluate the therapeutic effects of magnesium isoglycyrrhizinate in patients with antituberculosis drug-induced liver injury. Methods The literatures related to randomized controlled trials (RCT) of magnesium isoglycyrrhizinate treatment in patients with antituberculosis drug-induced liver injury were retrieved from CNKI, VIP, WanFang database, PubMed, EMbase and Cochrane Library. The collected literatures were published before April 2019. Based on the inclusive and exclusive criteria, the literatures were screened, and data were extracted by two researchers independently. Meanwhile the quality of the included studies was assessed. Meta-analysis was conducted by RevMan 5.2 software. Results 823 patients with antituberculosis drug-induced liver injury in ten RCT were enrolled. The meta-analysis demonstrated, a) compared with control group, the early-stage administration of magnesium isoglycyrrhizinate can effectively treat liver injury caused by antituberculosis drugs with statistical significance, and b) magnesium isoglycyrrhizinate can significantly reduce the alanine aminotransferase level and improve the total bilirubin level during the treatment. Conclusion Magnesium isoglycyrrhizinate administration is an effective treatment for liver injury caused by antituberculosis drugs although more high-quality researches are needed for further verification. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of fumarate hydratase antibody (anti-FH) in the differential diagnosis of autoimmune hepatitis (AIH) and drug-induced liver injury (DILI). Methods From March 2014 to December 2016, 105 patients with AIH who were hospitalized in Beijing You’an Hospital were enrolled as AIH group, and 92 patients with DILI were enrolled as DILI group. A total of 128 healthy individuals were enrolled as control group. ELISA was used to measure the serum level of anti-FH. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A consistency analysis of diagnostic compliance of anti-FH based on the Kappa test. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-FH in the diagnosis of AIH were analyzed. Results Compared with the DILI group, the AIH group had significantly higher positive rate of anti-nuclear antibody (72.4% vs 55.4%, χ2 = 6.147, P=0.013) and level of IgG ((18.3±6.1) g/L vs (15.2±5.4) g/L, t=-2.566, P=0.011)). The AIH group had a significantly higher positive rate of anti-FH than the DILI group and the control group (36.2% (38/67) vs 6.5% (6/92) and 2.3% (3/128), χ2=59.959, P＜0.001). In the diagnosis of AIH, anti-FH had a sensitivity of 36.2%, a specificity of 93.5%, a positive predictive value of 86.4%, and a negative predictive value of 93.5%. Conclusion Serum anti-FH has a certain reference value in the differential diagnosis of AIH and DILI. [ABSTRACT FROM AUTHOR]

Drug — induced liver injury ( DILI) is one of ihe main causes of acute liver failure, black box warnings, and drug withdrawal from the market, and it is also a major concern in public health, drug research and development, and the pharmaceutical industry. However, a lack of specific diagnostic markers for DILI makes the diagnosis of this disease a major challenge for clinicians. This article summarizes the recent advances in DILI research, including potential mechanisms, pathological features, biomarkers, and in vitro methods, in order to provide a reference for clinical and pathological diagnosis and prognostic evaluation of DILI. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the drugs responsible for drug-induced liver injury (DILI) in children and related risk factors, and to provide a reference for safe drug use in children in clinical practice. MethodsA retrospective analysis was performed for the clinical data of 187 children with DILI, aged 0-14 years, who were treated in The Fifth Medical Center of Chinese PLA General Hospital from January 2008 to December 2017, including medication history, biochemical parameters, symptoms/signs, and clinical outcome. Based on the method of integrated evidence chain, 127 children with medication information were divided into Western medicine-induced DILI group (Western medicine group with 75 children), traditional Chinese medicine (TCM)-induced DILI group (TCM group with 15 children), and the group with DILI induced by Western medicine and TCM (TCM-Western medicine group with 37 children). The reason for medication, medication time, latency of DILI, and drug classification were compared between groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups, and the Nemenyi test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. ResultsOf all 187 children with DILI, 116 (62%) had severe liver injury or above, among whom 3 underwent liver transplantation and 1 died, and 45 (24%) developed chronicity. In the Western medicine group and the TCM-Western medicine group, major suspected drugs for DILI were antibiotics, antipyretics, analgesics, and anti-inflammatory drugs, which accounted for 42%, 30%, 56%, and 31%, respectively. In the TCM group, the most common TCM drugs for DILI were those used to treat skin diseases, which accounted for 47% and were mainly the preparations of Fallopia multiflora (33%). There were significant differences between the three groups in medication time (H=11.658, P=0.003) and latency (H=10.945, P=0.004), and the TCM group had significantly longer medication time and latency than the other two groups (all P＜0.05). ConclusionMost children with DILI have serious conditions. The risk of liver injury due to medication in children should be taken seriously, and particular emphasis should be placed on the risk of liver injury caused by antibiotics, antipyretics, analgesics, and anti-inflammatory drugs and long-term use of some TCM drugs for skin diseases. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features of drug-induced liver injury (DILI) caused by antitumor drugs during the treat-ment of malignant tumors. Methods A retrospective analysis was performed for the clinical data of 56 patients who were diagnosed with ma-lignant tumors in Henan Provincial People’s Hospital from January 2015 to December 2016 and experienced DILI during the treatment withantitumor drugs, including sex, age, type of primary tumor, hepatotropic virus infection, liver function, type of chemotherapeutics, onsettime of liver injury, application of liver-protecting drugs, and outcome of liver injury. Results Among the 56 patients with DILI caused byantitumor drugs, 30 (53. 6%) had hepatocellular injury, and 45 (80. 4%) had mild liver injury. FOLFOX, GP/DP, and CHOP were themost common regimens for DILI, and of all 56 patients, 50 (89. 3%) had DILI caused by multiple drugs. Platinum-based drugs, anti-microtubule agents, and alkylating agents were the common drugs causing DILI. Of all 56 patients, 35 (62. 5%) developed DILI within 1-2 weeks after medication. Conclusion DILI caused by antitumor drugs mainly has a mild degree and hepatocellular injury type is the mostcommon clinical type. Platinum-based antitumor drugs and related chemotherapeutic regimens are the most common drugs for DILI. A com-bination of multiple antitumor drugs is more likely to cause DILI, and patients with such DILI often have a good prognosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features of patients with drug-induced liver injury (DILI) and vanishing bile duct syndrome (VBDS) and patients with primary biliary cholangitis (PBC) and VBDS. Methods A retrospective analysis was performed for the clinical data of 42 DILI patients and 43 PBC patients who visited Shijiazhuang Fifth Hospital from January 2003 to January 2018 were diagnosed with VBDS by liver biopsy, including general information, clinical symptoms and signs, and serological markers, and pathomorphological features were observed. The Mann-Whitney U rank sum test was used for comparison between two groups; the chi-square test was used for comparison of categorical data between groups. Results Most of the patients in the two groups were female patients aged 40-50 years. The D-VBDS group had a significantly higher incidence rate of yellow staining of skin and sclera than the P-VBDS group (χ2=5.683, P=0.017). Comparison of the peak values of liver biochemical indices showed that compared with the P-VBDS group, the D-VBDS group had significantly higher total bilirubin (Z=-2.020, P=0.043) and direct bilirubin (Z=-2.910, P=0.004). According to the results of pathomorphological analysis and morphological scores of the portal area, the P-VBDS group had significantly higher morphological scores of portal inflammation, fibrosis, and granuloma than the D-VBDS group (Z=-3.136, -2.710, and -2.913, P=0.002, 0.007, and 0.005). The morphological scores of the hepatic lobules showed that compared with the P-VBDS group, the D-VBDS group had significantly higher morphological scores of intralobular inflammation, bile thrombus in bile capillary, and activated phagocytes (Z=-3.255, -2.455, and -4.398, P=0.001, 0.014, and ＜0.001). Conclusion Pathomorphological features of the liver are objective and accurate indices for the differentiation between DILI with VBDS and PBS with VBDS and have great significance in making a definite diagnosis, understanding the degree of injury, and predicting prognosis. [ABSTRACT FROM AUTHOR]

Drug-induced cholestasis (DRIC) mainly includes cholestasis-type and mixed-type drug-induced liver injury (DILI). The Roussel Uclaf Causality Assessment Method scale should be used to determine the causality between drug and cholestasis and other etiologies should be excluded. Liver biopsy may help with differential diagnosis. Drugs should be stopped after the development of DRIC to avoid stimulation, and ursodeoxycholic acid should be administered for treatment. DRIC has a complex pathogenesis, which involves the direct toxicity of drugs and their metabolites on hepatocytes and the biliary tree, immune and inflammatory response, gene polymorphism and inhibition of key enzymes and transporters in the pathways of drug metabolism and efflux, and HLA gene polymorphisms. Clarification of these pathogeneses helps with the early warning, prevention, and optimized treatment of DRIC. [ABSTRACT FROM AUTHOR]

Tuberculosis patients with positive antibody to hepatitis C virus(TB-HCV patients) are often seen in clinical practice, and these TB-HCV patients include those with HCV infection. That makes the clinical management and diagnosis/treatment of TB-HCV difficult. This article introduces the prevalence of TB-HCV around the world, and analyzes the potential issues in the diagnosis and treatment of TB-HCV patients, such as drug-drug interactions, drug-induced liver injury, HCV reactivation, and TB reactivation. Through this review, it is recommended that the management should be strengthened and the appropriate therapeutic regimen should be selected in the diagnosis and treatment of TB-HCV patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the characteristics of drug-induced liver injury in patients with lung cancer after chemotherapy, so as to provide reference for clinical drug use. METHODS: Retrospective analysis was conducted on 453 patients with lung cancer who were included in the first-line chemotherapy for clinical pathology in Gansu Provincial Cancer Hospital (hereinafter referred to as “our hospital”) from Jan. 2010 to Dec. 2014. The incidence, severity, clinical type, patient characteristics and prognosis of drug-induced liver injury after different chemotherapy regimens were statistically applied. RESULTS: The incidence of liver injury in three lung cancer chemotherapy regimens of EP regimen (etoposide + cisplatin), GP regimen (gemcitabine + cisplatin) and DP regimen (docetaxel + cisplatin) was 6. 2% (7/113),15. 9% (30/189) and 7. 3% (11/151), and the incidence of liver injury in GP regimen was significantly higher than that in EP and DP regimes, and the difference was statistically significant (P < 0. 05), and there was no significant difference in the incidence of liver injury between EP and DP regimens (P > 0. 05). The types of liver injury caused by different chemotherapy regimens were different, the liver injury induced by DP regimen was mostly cholestasis-type liver injury (63. 6%,7/11), and the EP regimen showed mixed liver injury (71. 4%,5/7), GP regimen was mostly manifested as hepatocyte injury-type liver injury (56. 7%,17/30). Liver damage induced by three chemotherapy regimens can be cured or returned. CONCLUSIONS: Among the three lung cancer chemotherapy regimens, the incidence of liver injury induced by GP regimen is higher and more serious. The types of liver injury induced by each regimen have different characteristics, and the clinical prevention and treatment can be carried out according to these characteristics. [ABSTRACT FROM AUTHOR]

Drugs are an important cause of liver injury, and according to statistics, about 1100 drugs may induce liver injury. Due to the difficulty in differential diagnosis, drug-related liver injury is still misjudged. As different drugs have different mechanisms of action in inducing liver injury and may cause different degrees of liver injury, targeted countermeasures should be adopted. There are fewer systematic reviews of liver injury caused by chemotherapy drugs. This article mainly introduces the hepatotoxic mechanisms of various chemotherapy drugs, elaborates on the degree of hepatotoxicity caused by chemotherapy drugs, summarizes the clinical manifestations of liver injury caused by chemotherapy drugs, and gives recommendations to clinical treatment. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aims to establish the ultra-performance liquid chromatography(UPLC) fingerprint and multi-indicator quantitative analysis method for Schisandrae Sphenantherae Fructus(SSF) and to screen out the potential quality markers(Q-markers) of hepatoprotection based on network pharmacology. The similarity analysis was performed using the Chinese Medicine Chromatographic Fingerprint Similarity Evaluation System, which showed that the similarity of the fingerprints of 15 samples from different regions ranged from 0.981 to 0.998. Eighteen common components were identified, from which 3 differential components were selected by cluster analysis and principal component analysis. The &quot;component-target-pathway&quot; network was built to predict the core components related to the hepatoprotective effects. Fourteen core components were screened by network pharmacology. They acted on the targets such as AKT1, CCND1, CYP1A1, CYP3A4, MAPK1, MAPK3, NOS2, NQO1, and PTGS2 to regulate the signaling pathways of lipid metabolism and atherosclerosis, hepatitis B, interleukin-17, and tumor necrosis factor. Considering the chemical measurability, characteristics, and validity, schisantherin A, anwulignan, and schisandrin A were identified as the Q-markers. The content of schisantherin A, anwulignan, and schisandrin A in the test samples were 0.20%-0.57%, 0.13%-0.33%, and 0.42%-0.70%, respectively. Combining the fingerprint, network pharmacology, and content determination, this study predicted that schisantherin A, anwulignan, and schisandrin A were the Q-markers for the hepatoprotective effect of SSF. The results can provide reference for improving the quality evaluation standard and exploring the hepatoprotective mechanism of SSF.

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

谢雯，主任医师，教授，硕士研究生导师，首都医科大学附属北京地坛医 院肝病中心主任。担任中华医学会肝病学分会委员、北京医学会肝病学分会副主任委员、 北京肝病学分会药物性肝病学组组长、国家科技奖励评审专家、国家发改委药品价格评审 中心评审专家、CFDA 药物评审委员。先后担任《中华肝脏病杂志》《中华实验和临床感染病 杂志：电子版》《中国肝脏病杂志：电子版》《肝脏》《临床肝胆病杂志》《中国医刊》《中国临床 医生》等多家杂志编委。长期从事肝脏疾病基础及临床研究，承担国家自然科学基金、北京 市科委重点支持项目、扬帆计划等多项研究，发表论文30 余篇。 [ABSTRACT FROM AUTHOR]

陈军，教授，博士研究生导师。湖南省预防医学会肝病委员会主任委员， 中华肝脏病学学会药物性肝病学组委员，湖南省药物性肝病学组组长，中国研究型医院学 会肝病分会肝纤维化学组副组长，中国医师学会中西医肝病学会常委，湖南省感染病学会 委员，湖南省225 人才培养计划感染病学学科学术带头人。 长期从事传染病和肝脏疾病临床、教学和科研工作，以项目负责人承担了国家自然科 学基金和多个省部级科研课题。以第一作者或通讯作者发表论文30 多篇，其中SCI 论文 10 余篇，包括Clin Gastroenterol Hepatol（IF7.6799）和J Virol（IF5.741）。《中华肝脏病杂志》 《肝脏》《临床肝胆病杂志》编委，为多家国际著名刊物如Hepatology、Hepatol Int 等担任审稿 人。2007 年在17 届亚太国际肝病年会做特别演讲，并作为5 位获奖者之一获得最高荣誉 奖——主席奖（Presidential Award）。相关研究成果获得湖南省科技进步奖三等奖、湖南省医 学会二等奖。以第一完成人获得国家发明专利1 项。 [ABSTRACT FROM AUTHOR]

At present,Drug-induced liver injury(DILI) has become the most common cause of acute liver injury in clinical practice. This article elaborates on the pathogenesis of DILI,new biomarkers,liver tolerance to drug toxicity,adaptability and susceptibility,and testing threshold of alanine aminotransferase. Meanwhile,we should understand the development history of diagnostic scale,develop unified standards and understanding,and attach importance to DILI induced by medicinal herbs and dietary supplements,and in-depth studies on the pathogenesis of DILI should be performed to prevent or reduce DILI. There are several problems in DILI studies in China and obvious gaps between China and foreign countries,with a lack of basic research and blanks in clinical aspects. Therefore,we must strive to keep up with international research so that drugs can better serve the human. [ABSTRACT FROM AUTHOR]

Objective To analyze and summarize the clinical data of drug-induced liver injury(DILI),and to investigate the clinical features and prognosis of DILI. Methods A retrospective analysis was performed for the clinical data of 95 patients with DILI who were admitted to The First Affiliated Hospital of Xi’an Medical University from February 2010 to February 2016,including sex,age,medication history,underlying diseases,clinical manifestation,laboratory and imaging findings,treatment,and prognosis. A logistic regression analysis was used to investigate the influencing factors for prognosis. Results Respiratory system diseases ranked first among the underlying diseases treated by drugs that caused DILI and accounted for 25. 26%(24/95),and of all patients,23. 16%(22/95) had tuberculosis. Among the drugs that caused DILI,traditional Chinese medicine ranked first and accounted for 44. 21%(42/95),followed by antitubercular agents which accounted for 22. 11%(21/95). DILI often occurred within 15-30 days of medication. Poor appetite was the most common symptom of DILI,and jaundice was the most common positive sign. Elevated alanine aminotransferase was the most common laboratory result of DILI.Acute hepatocellular injury type was the most common type of DILI. Most DILI patients had good prognosis,and patients with response to treatment accounted for 95. 79%(91/95),including those who were improved or cured. Age(odds ratio [OR]= 0. 054,95% confidence interval(CI) : 0. 002-0. 076,P = 0. 037),alkaline phosphatase(OR = 0. 004,95% CI: 0. 001-0. 006,P = 0. 043),total bilirubin(OR = 0. 028,95% CI: 0. 001-0. 039,P = 0. 035),and direct bilirubin(OR = 0. 008,95% CI: 0. 001-0. 014,P = 0. 036) were independent risk factors for prognosis. Conclusion DILI does not have specific clinical manifestations and can easily be missed or misdiagnosed. Clinicians should use drugs rationally,monitor the presence of hepatotoxicity,and strengthen the public health education on safe medication. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features of drug-induced liver injury(DILI) and related risk factors. Methods A retrospective analysis was performed for the clinical data of 208 patients who were diagnosed with DILI in The Affiliated Hospital of Southwest Medical University from January 2013 to November 2017,including the type of drugs,clinical data,and laboratory examination results,and among these patients,80 with DILI caused by antitubercular agents,antitumor drugs,and immune agents were enrolled as observation group. A total of 80 patients who used these three types of drugs and did not develop DILI were enrolled as control group. Related risk factors were analyzed. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups. The chi-square test was used for unordered variables of categorical data,the Mann-Whitney U test was used for ranked data,and a logistic regression analysis was used to identify risk factors. Results Of all patients with DILI,30. 8% had DILI caused by traditional Chinese medicine. There were significant differences in sex,alanine aminotransferase,aspartate aminotransferase(AST),total bilirubin(TBil),gamma-glutamyl transpeptidase(GGT),and total bile acid(TBA) between patients with different types of DILI(χ2= 6. 081,H = 54. 349,45. 993,78. 902,49. 940,and 21. 934,all P < 0. 05). There were significant differences in AST,TBil,GGT,and TBA between the patients with different prognoses(H = 1. 728,6. 322,6. 440,and 2. 353,all P < 0. 05). Smoking(odds ratio [OR]= 2. 856,P = 0. 026),diabetes(OR = 2. 726,P = 0. 042),hyperlipidemia(OR = 3. 390,P = 0. 003),and body mass index(BMI) ≥28 kg/m2(OR = 3. 142,P =0. 009) were risk factors for DILI. Conclusion Most DILI cases are caused by traditional Chinese medicine,and hepatocellular type is the most common type of liver injury. Smoking,diabetes,hyperlipidemia,and BMI ≥28 kg/m2 are risk factors for DILI. [ABSTRACT FROM AUTHOR]

Drug-induced liver injury(DILI) and autoimmune hepatitis(AIH) have many similar clinical and histological manifestations,which brings difficulties to clinicians in differential diagnosis. This article elaborates on the association between DILI and AIH and their similarities and differences in clinical and histological manifestations,in order to help clinicians with the differential diagnosis of DILI and AIH.This article reviews the selection of therapeutic regimens for DILI and AIH and introduces how to select therapeutic strategies based on patient conditions and make a definite diagnosis when there are difficulties in differential diagnosis. [ABSTRACT FROM AUTHOR]

Due to a lack of specific biomarkers,the diagnosis of drug-induced liver injury(DILI) mainly depends on the method of exclusion. The Roussel Uclaf Causality Assessment Method(RUCAM) scale is the most widely used causality assessment scale and is relatively objective,but it is still waiting for further improvement. Another method is global introspection or expert opinion,which is relatively subjective,and the simplified global introspection method is commonly used in clinical practice. The Structured Expert Opinion Procedure(SEOP)created by the US DILI network(DILIN) is very complicated and time-consuming and thus cannot be used in clinical practice. The drug rechallenge test(DRT) with a positive result is considered the gold standard for the diagnosis of DILI,but DILI cannot be excluded based on the negative result of DRT. The value of lymphocyte transformation test(LTT),modified LTT,monocyte-derived hepatocyte-like cell lactate-dehydrogenase release test,and various predictive models for drug hepatotoxicity in the diagnosis of DILI awaits further assessment.The differential diagnosis of autoimmune-mediated DILI and traditional autoimmune liver diseases usually depends on liver biopsy,the type and titer of autoantibody,and response to glucocorticoids. Reasonable timing of drug withdrawal and application of anti-inflammatory liver-protecting drugs may help most DILI patients recover. Generally,the prophylactic use of anti-inflammatory liver-protecting drugs is not recommended,except in special situations. In-depth studies are needed for the precise diagnosis and prevention/treatment of DILI. [ABSTRACT FROM AUTHOR]

Objective To provide theoretical basis for the rational use of drugs in clinic， the biochemical characteristics of liver injury induced by Atorvastatin Combined with HRZ（Isoniazid Rifampicin and Pyrazinamide） were analyzed in animal model. Methods Eighty 8 week old SPF SD rats with half males and females were divided into four groups: control group，atorvastatin group，HRZ group，atorvastatin+HRZ group. According to the human mouse drug dose conversion，mice were given corresponding drugs by gavage．Hepatic function index of rats （the Total bilirubin， Direct bilirubin， Indirect bilirubin，Aspartate aminotransferase， Alanine aminotransferase， Alkaline phosphatase） were detected by blood from the femoral artery and hepatic function index of rats in each group on 10 d，20 d，40 d．Results There were significant difference in the anmmistrated group on 10，20，40 days with higher TBIL， DBIL， IBIL than that in control group； in the admimistrated group on Day 10， combined treatment group was higher than that in cotrol group and there were significant differences in ALT；in the process of treatmen， there was statistical difference； ALP was administered for 20 days and the 40 day， atorvastatin there was HRZ group was statistically different in group HRZ， severe injury ， combination group compared with HRZ group had statistically significant difference. Conclusions The liver injury in the three experimental groups is mild and moderate， and the liver damage is mainly cholestasis type. The most severe hepatic injury caused by Atorvastatin Combined with HRZ is aggravated by the prolonged use of drugs. [ABSTRACT FROM AUTHOR]