Glycyrrhizic Acid Prevention Reducing The Incidence Rate Of Liver Injury In Anti Tuberculosis Treatmen:a Meta Analysis

Objective:To evaluate the effects and safety of prophylactic use of glycyrrhizic acid preparation on the incidence,degree,time of liver injury caused by tuberculosis drugs during the standard short course anti tuberculosis treatment?2HRZE/4HR?for patients with new pulmonary tuberculosis.Methods:Searched the PubMed,Cochrane Library,Embase,CNKI,CBM,VIP and WanFang Data by two searchers,the retrieved literatures were all related to anti tuberculosis treatment and preventive use of glycyrrhizic acid preparation,the retrieval time was since the set up in databases to October 1,2017,and the retrieval language was in Chinese or English.Two searsears independently screened literatures,collected and established the final research,then extracted the general information and specific data and evaluated methodological quality,finally used RevMan 5.3 software to carry out Meta analysis.Results:Finally,13 randomized controlled trials?RCT?were included in the study of literature,all languages are Chinese,no English literature conform to the inclusion criteriastandard included.In this study,2679 cases were included in the study,including 1382 cases in the glycyrrhizin group?observation group?and 1297 cases in the non preparation of glycyrrhizic acid group?control group?.Glycyrrhizic acid preparation group was further divided into 666 cases of compound glycyrrhizin group and 716 cases of diammonium glycyrrhizinate group.The Meta analysis results showed that:1.Comparison of the incidence rate of liver injury:The incidence of liver injury in glycyrrhizic acid was significantly less than that in non glycyrrhizic acid group?RR=0.26?,the diammonium glycyrrhizinate group was significantly better than the compound glycyrrhizin group in reducing the incidence of liver injury,RR₂?0.24?<RR₁?0.30?,the difference was statistically significant?P<0.05?.2.Comparison of the damage degree of liver injury:the glycyrrhizic acid group reduced the degree of elevation of ALT,AST,TBIL level was better than non glycyrrhizic acid group,the difference was statistically significant?P<0.05?.The glycyrrhizic acid group reduced the reduction degree of ALB level was better than non glycyrrhizic acid group,the difference was no statistically significant?P>0.05?.The average level of TP before treatment in glycyrrhizic acid group was lower than that after treatment?MD₁=-5.54?,the average level of TP before treatment in non glycyrrhizic acid group was higher than that after treatment?MD₂=5.50?,the difference was no statistically significant?P>0.05?.3.Comparison of the time of occurrence of liver injury:the incidence of liver injury in the fortified period was significantly higher than the consolidation period both in the glycyrrhizic acid group and the non glycyrrhizic acid group during the 2HRZE/4HR treatment?RR=6.25?,the difference was statistically significant?P<0.00001?.4.Comparison of the occurrence of adverse reactions:New pulmonary tuberculosis patients in the standard range of anti tuberculosis treatment and prophylactic use of glycyrrhizic acid,there was no obvious malignant adverse events,most of the adverse events were common digestive tract symptoms mainly caused by anti tuberculosis drugs,which could be restored to normal after intervention.Conclusion:In the treatment of 2HRZE/4HR in patients with pulmonary tuberculosis,the prophylactic use of glycyrrhizic acid can reduce the incidence of liver injury induced by anti tuberculosis and alleviate the damage degree of liver injury,especially the effect is greater in the strengthening period,and no obvious adverse reaction is added.