Clinical analysis of 128 cases with liver injury caused by chemotherapy drugs

JIN Ming-gui; LIU Kai-jun; WEN Liang-zhi; WANG Bin; SUN Wen-jing; CUI Hong-li; CHEN Dong-feng; YAN Qi-xian

doi:10.3969/j.issn.1007-8134.2017.05.013

Abstract：Objective To analyze the clinical characteristics of drug-induced liver injury (DILI) caused by chemotherapeutic drugs, and to provide clinical data for effectively reducing the incidence and mortality of DILI. Methods According to the 2015 edition of Guidelines of Diagnosis and Treatment of Drug-Induced Liver Injury, 128 DILI cases from January 2012 to December 2016 in our hospital were included and their clinical data were collected. Type of chemotherapy drugs, DILI onset time, severity, treatment and clinical outcome were analyzed. Results There were 128 patients in this analysis, including 46 males (30.51%) and 82 females (69.49%). The minimum age was 24-year, and the maximum age was 82-year, with an average of (53.2±5.4) year-old. The DILI onset time was from 2 to 30 days, with an average of (16.3±2.4) days. The main chemotherapeutic agents that caused DILI included paclitaxel, platinum, cyclophosphamide, adriamycin and so on. The combination of chemotherapy drugs increased the incidence and severity of liver injury. The severity of DILI included grade 1 (mild liver injury) in 74 cases (57.81%), grade 2 (moderate liver injury) in 44 cases (34.38%), grade 3 (severe liver injury) in 8 cases (6.25%), grade 4 (liver failure) in 1 case (0.78%), and grade 5 (death) in 1 case (0.78%). According to the 2015 edition of Guidelines of Diagnosis and Treatment of DILI, patients with grade 1 liver injury continued to use chemotherapuetic drugs, and meanwhile received oral polyene phosphatidylcholine capsule and diammonium glycyrrhizinate enteric-coated capsules. Patients with grade 2 liver injury were given intravenous injection of polyene phosphatidylcholine and magnesium isoglycyrrhizinate. Patients with grade 3 liver injury were intravenously injected with polyene phosphatidylcholine, magnesium isoglycyrrhizinate, and butadisulfonate adenosine. Glucocorticoid and plasma replacement can be also used if necessary. Patients in grade 4 and 5 were given glucocorticoid and plasma replacement besides conventional treatment. The majority of patients had good prognosis, of which 117 cases cured (91.40%), 1 case died (0.78%), 2 cases developed into chronic cirrhosis (1.5%), and 8 cases gave up the treatment (6.25%). Conclusions DILI caused by chemotherapy drugs is not uncommon. Liver function should be routinely monitored for patients receiving chemotherapy. DILI should be detected and treated actively and effectively. DILI caused by most chemotherapy can be cured and the prognosis is satisfied.