| disease | Drug-induced Liver Cirrhosis |
Liver damage caused during medication can lead to drug-induced cirrhosis.
bubble_chart Etiology
There are numerous types of drugs that can cause various liver injuries, totaling over 200 kinds. These include non-steroidal antipyretic analgesics such as vinegar acetaminophen, muscle relaxants, anesthetics, anticonvulsants, antibiotics, antifungals, and anti-Chinese Taxillus Herb parasitic drugs, anti-subcutaneous node drugs, anticancer drugs and immunosuppressants, hormonal drugs, oral hypoglycemic agents, antithyroid drugs, H2-receptor blockers, psychiatric drugs, and so on. According to statistics, patients with drug-induced liver injury account for about 10-15% of all drug reaction cases, with an incidence rate second only to skin and mucous membrane injuries and drug fever.
Drug-induced injuries can be divided into predictable (usually dose-related) and non-predictable (or idiosyncratic, often unrelated to dose). Predictable injuries can be replicated in animal models, often affecting specific areas of the liver lobules, and because they are dose-related, such drugs are referred to as "direct hepatotoxic" drugs. Non-predictable injuries are often diffuse and are presumed to be allergic reactions to the drug, with immune mechanisms being the direct cause of liver cell injury. Non-predictable injuries cannot be replicated in corresponding animal models.
Current views suggest that non-predictable injuries are due to the production of toxic metabolites to the liver during the biotransformation of certain drugs, leading to liver lesions. Due to differences in individual drug metabolism pathways and rates, especially variations in P450
activity, differences in detoxification mechanisms, etc., the accumulation of toxic metabolites in the liver increases, making certain individuals more susceptible to liver injury.bubble_chart Pathological Changes
Drugs can cause several types of liver cirrhosis: ① Macronodular or post-necrotic cirrhosis, usually developing from drug-induced chronic active hepatitis or subacute hepatic necrosis. ② Cirrhosis accompanied by fatty degeneration, morphologically presenting as micronodular or macronodular. ③ Gall fel cirrhosis. ④ Congestive cirrhosis, caused by occlusion of hepatic veins or small intrahepatic veins (such as 6-mercaptopurine).
bubble_chart Clinical Manifestations
1. History of taking drugs that injure the liver, especially those that can cause chronic active hepatitis, such as diacetoxy diphenyl, methyldopa, acetaminophen, aspirin, amiodarone, sulfonamides, etc. Some drugs may progress insidiously to cirrhosis, such as methotrexate.
2. Clinical manifestations of cirrhosis, such as portal hypertension and its complications including upper gastrointestinal bleeding, ascites, hepatic encephalopathy, etc.
3. Liver biopsy confirmed as cirrhosis.
4. Excluding cirrhosis caused by other reasons, such as various viral hepatitis, with all serum markers negative. Excluding cardiac cirrhosis, etc.
bubble_chart Treatment Measures
1. Immediately discontinue the use of related or suspected drugs.
2. Enhance nutrition, such as high protein, vitamin B complex, and vitamin C.
3. Use liver-protective drugs, such as Livact, etc.
Symptomatic treatment, such as upper consumptive thirst, gastrointestinal bleeding, ascites, hepatic encephalopathy, etc., should be treated accordingly.
Drug-induced liver cirrhosis focuses on prevention, particularly the prevention of early drug-induced injury. For instance, liver function should be regularly monitored during drug treatment, and patients with pre-existing liver or kidney diseases should have their liver function closely monitored during medication. For patients with a history of grade I drug-induced liver damage, the use of the same or chemically similar drugs should be avoided. For drug-induced chronic active hepatitis or liver fibrosis, anti-fibrotic drugs such as Salvia and Chinese Angelica should be applied early.
Additionally, based on the mechanism of drug-induced liver injury, targeted drugs can be selected and used in conjunction with therapeutic drugs to prevent liver injury. For example, metyrapone can inhibit cytochrome P450 activity, acetylcysteine can promote GSH synthesis, and acetylsalicylic acid can reduce calcium ion concentration.
