Study On The Rationality Of Hepatoprotective Drugs For Drug-induced Liver Injury Caused By Chemotherapy

Objective: To systematically evaluate the preventive effect of commonly used hepatoprotective drugs on drug-induced liver injury which caused by tumor chemotherapy.Compare the safety and efficacy between magnesium isoglycyrrhizinate and glutathione in the prevention of DILI(drug-induced liver injury)in cancer patients during chemotherapy by retrospective cohort analysis.At the same time,the commonly used traditional Chinese medicine injections were analyzed by meta-analysis.Methods:1.Systematic review of commonly used hepatoprotective drugs: A comprehensive search which conducted Embase,Pub Med,Cochrane Library,Web of science,CNKI,CBM,VIP,and Wanfang databases from inception to August 2020.With the inclusion and exclusion criteria,independly screened the clinical randomized controlled trials which using,glutathionebicyclol or magnesium isoglycyrrhizinate as preventive hepatoprotective drugs while carrying out anti-tumor chemotherapy.Screened the literature for quality evaluation.Rev Man 5.3 software was used for meta-analysis.2.Clinical research : Including 359 cancer patients in the Department of oncology.All of they are received chemotherapy during January 2014 to July 2019.The patients were divided into three groups,including group A,group B and group C.Control group A of 118 cases,only received chemotherapy patients.B(120 cases):Patients who were in this group using glutathione injection and regular chemotherapy.C(121cases):Patients who were in group C were treated with magnesium isoglycyrrhizinate and regular chemotherapy.3.Systematic review of commonly used traditional Chinese medicine: A comprehensive search about the common traditional Chinese medicine injections(Shenqi Fuzheng,Kangai,Huangqi,Aidi,Xiaoaiping)in gastric cancer patients who concurrently get the chemotherapy in Embase,Pub Med,Cochrane Library,Web of science,CNKI,CBM,VIP,and Wanfang databases from the inception to July2020,The data were extracted from the selected literatures.Rev Man 5.3 is used for data analysis.Results:1.Systematic review: There were 2230 patients in these 12 RCTs in this study.According this study we get the result that using hepatoprotective prophylacically could reduce the incidence of drug-induced liver injury(RR = 0.43,95% CI: 0.30 ～ 0.61,P <0.01),especially in patients with grade 3/4 liver injury(RR = 0.33,95% CI: 0.25 ～ 0.43,P < 0.01),and reduce the levels of ALT(MD =-32.03,95% CI:-47.11 ～-16.95,P <0.01),AST(MD =-25.61,95% CI:-38.15 ～-13.07,P < 0.01)and TBIL(MD =-3.82,95% CI:-5.97 ～-1.67,P < 0.01),but had no significant effect on ALP(MD =-19.90,95% CI:-54.86 ～ 15.06,P = 0.26)and DBIL(MD =-2.09,95% CI:-5.12 ～ 0.95,P =0.18).2.Clinical research part: the incidence of liver injury in group A,B and C after one cycle of chemotherapy was 94.07%,36.67% and 34.71%.The incidence of 3 or 4 degree liver injury was 7.63%,0%,0.83%.There was significant difference between group B,C and group A(P < 0.05),but there was no significant difference between two observation groups.There was no obvious discrepancy in AST,ALT,TBIL and ALP among the three groups before this observation(P > 0.05).After one cycle of chemotherapy,the indexes of observation group(B,C)were better than those in group A,and these differences were evident(P < 0.05).3.In the part of systematic review of traditional Chinese medicine,37 articles were included,including 2779 samples.The incidence of cancer was significantly reduced by injection(RR = 0.54,95% CI: 0.46 ～ 0.63,P < 0.01).At the same time,the secondary outcome analysis of blood indexes and other adverse reaction indexes showed that Chinese medicine intervention chemotherapy had protective effect on reducing leucopenia(RR = 0.71,95% CI: 0.66 ～ 0.77,P < 0.01),thrombocytopenia(RR = 0.68,95% CI: 0.60 ～ 0.78,P < 0.01),and renal function damage(RR = 0.60,95% CI: 0.43 ～0.83,P < 0.01),reducing nausea and vomiting(RR = 0.76,95% CI: 0.70 ～ 0.82,P <0.01),reducing diarrhea(RR = 0.67,95% CI: 0.55 ～ 0.83,P < 0.01),and reducing neurotoxicity(RR = 0.66,95% CI: 0.56 ～ 0.79,P < 0.01).At the same time,traditional Chinese medicine dry pre chemotherapy may also reduce the incidence of alopecia(RR =0.85,95% CI: 0.72 ～ 1.00,P = 0.05).Conclusion:1.Systematic review of commonly used hepatoprotective drugs:hepatoprotective drugs may have an impact on the prevention of drug-induced liver injury caused by chemotherapy.2.Clinical research part: compared with chemotherapy alone,glutathione and magnesium isoglycyrrhizinate injection can effectively prevent drug-induced liver injury(DILI)caused by chemotherapy,and preventive liver protection used concurrently with chemotherapy can not only be favourable for liver indexes,but also can relieve patients’ pain,and get better remedy effect.3.Systematic review of commonly used traditional Chinese medicine: Meta-analysis results shows that chemotherapy with traditional Chinese medicine can effectively decrease the incidence of adverse reactions.