CIOMS /RUCAM Maria 113 BMI ± % % AIH F P = Maria

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1 1058 J Clini Hepatol October 2011 Vol. 27 No. 10 / CIOMS /RUCAM Maria ~ BMI ± % % % 1 AIH F P = HAI 9 F % % CIOMS /RUCAM % Maria % AIH HAI 9 F 4 CIOMS /RUCAM Maria RUCAM Maria R575 A The analysis of clinical features and risk factors in 113 patients with drug - induced liver injury DAI Wei - jia LAI Rong - tao WANG Hui et al. Department of Infection Ruiijin Hospital Shanghai Jiaotong University School of Medicine Shanghai China Abstract Objectives To analyze the clinical manifestation and influencing factors of drug - induced liver injury DILI and to compare the accuracy of two diagnostic criteria CIOMS / RUCAM and Maria score. Methods Retrospective analysis was performed on 113 patients who have been diagnosed as drug - induced liver injury by liver biopsy in Ruijin hospital between July 2008 and November Age sex BMI serological indicators liver biopsy histologic changes causes clinical manifestation and prognoses were recorded. Results Among the 113 patients 77 patients were female and 36 patients were male. The average age was ± Chinese herbal medicine and diet tea were the main causes of DILI % followed by antibiotics antipyretic analgesic anti - inflammatory drugs and cardiovascular drugs. The main symptoms were asthenia nausea and epigastric discomfort. Classification % of the patients were the injury type of hepatocytes and most of them were female. The rest were the type of cholestasis and mix type % of the patients reached to normal liver function after 1 month treatment. Ishak fibrosis score F of the patients with the complication - AIH was high P = There were 7 cases 6. 19% falling into both histological activity index HAI 9 and F 4 and % of them kept the liver function abnormal o- ver half a year or died. CIOMS /RUCAM score 6 and Maria score 10 were % and % respectively. Conclusion Chinese herbal medicine and diet tea were the main causes of DILI. Most of patients reinstated well after abandoning the medicine. Most of the hepatocytes type were female. The complication - AIH would influence over Ishak fibrosis score. Patients with HAI 9 and F 4 had poor prognosis. The sensitivity of RUCAM score was higher than Maria score. Key words hepatitis toxic RUCAM score Maria score No No wanghuirjrj@ yahoo. com. cn drug - induced liver injury DILI

2 % 36 / 113 CIOMS / % % RUCAM 1 Maria 2 ALT P = ~ >0. 05 χ 2 = P > χ 2 = P > χ 2 = ~ ± P > χ 2 = P > χ 2 = P > AIH AIH CHB CHC % 7/ 113 CHB 7. 96% 9/ 113 CHC 1. 77% 2/ 113 AIH F P = B 16G 1 s 1 1 cm 4 1 4% % 61 / % 48 / % 31 / % 17 / % 9 / % HAI Ishak SPSS % 21 /113 x ± s t 5. 31% 6 /113 Kruskal Wallis P < ALT 3 ULN 2 ALT/ULN / ALP/ULN % 54/ ALP 2 ULN ALT/ ULN / ALP/ULN ~ % 17/113 ALT 3 ULN ALP 2 10 ULN 2 < ALT/ULN / ALP/ULN < % 26/ 10 ~ ~ ~ ~ ~ ~ ~ ~ 90 8 Kruskal - Wallis % 14/54 ALT P = % RUCAM 55 50/ % t ALT P = ALT 7. 08% 8/113 3 P = % 77 / χ 2 = P % 18/113 AIH AIH 1 / % 13 / % 16/ % 40/54 15/ % 7/113 2

3 1060 J Clini Hepatol October 2011 Vol. 27 No % % % % % % % % % % / % HAI 9 F 4 7 t ALT % 3/7 P 1 = P 2 = χ 2 =6. 97 P <0. 01 P = RUCAM P = Maria P = DILI 3 Ⅲ Kupffer HAI % 21 / 113 F % 17 / 113 HAI % 11 / 113 F P = P = Ishak RUCAM < % 25 /113 Maria P = F P = < % 45 /113 SPSS Maria 95% ~ RUCAM 95% ~ HAI % 11/ % 2/ % 5 / 113 F % 6/ % 4/ %

4 x ± s ALT U /L 609 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± AST U /L ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ALP U /L 163 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± GGT U /L 191 ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± TBil μmol /L ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ALT 10 ~ 64 U /L AST 8 ~ 40 U /L ALP 38 ~ 126 U /L GGT 7 ~ 64 U /L TBil 5. 1 ~ μmol /L ALT 3 ALT /ULN / ALP /ULN % % 1 ~ 2 6 HAI F AIH % vs % P < %

5 1065 / 1 Zimmerman HJ Ishak KG.General aspects of drug -induced liver disease J.Gastroenterol Clin North Am Benichou C.Criteria of drug -induced liver disouders.report of an international consensus meeting J.J Hepatol Kin DJ.The assessment of toxic liver injury J.Korean J Gastroenterol J J M.. J AIH RUCAM Maria AIH CHB CHC % RUCAM < % Maria < % DILI RUCAM % Maria 10 DILD % RUCAM 6 DILD % clinical features and outcomes from a prospective study of drug -induced liver injury in the United States J.Gastro- RUCAM Maria RUCAM enterology Danan G Benichou C.Causality assessment of adverse reactions to drugs -I.A novel method based on the conclusion of international consensus meetings application to drug -induced fiver injuries J.Clin Epidemiol Maria VA Victorino RM.Development and validation of a clinical scale for the diagnosis of drug -induced hepatitis J.Hepatology Ishak K Baptista A Bianchi L et al.histological grading and staging of chronic hepatitis J.J Hepatol Benichou C.Criteria of drug -induced liver disorders J.J Hepatol Zimmerman HJ Ishak KG.General aspects of drug -induced liver disease J.Gastroenterol Clin Nort Am Bell LN Chalasani N.Epidemiology of idiosyncratic drug -induced liver injury J.Semin Liver Dis Chalasani N Fontana RJ Bonkovsky HL et al.causes e Cotreau MM von Moltke LL Greenblatt DJ.The influence of age and sex on the clearance of cytochrome P450 3A substrates J.Clin Pharmacokinet Kazutot T Yukihiros S.Practical guidelines for diagnosis and early management of drug -induced liver injury J.World J Gastroenterol

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