Systematic Review Of Traditional Chinese Medicine In The Treatment Of Drug-induced Liver Injury And Analysis Of Medication Rules

Objective To evaluate the efficacy and safety of traditional Chinese medicine intervention in the treatment of drug-induced liver injury(DILI)by systematic evaluation,so as to provide real and reliable evidence-based medicine for clinical treatment of DILI.At the same time,we explored the prescription of traditional Chinese medicine in treating DILI,analyzed the medication rule of traditional Chinese medicine in treating DILI,and discussed the pathogenesis of DILI,providing reference for clinical medication of DILI.Methods The randomized controlled study(RCT)of Chinese medicine treatment DILI collected from CNKI,Wanfang database,VIP database,PubMed,EMBASE and other large Chinese and English databases was searched.According to the inclusion criteria and exclusion criteria,the literature was screened,and the general data,intervention measures,control measures,outcome index data,safety evaluation and other data were extracted,and the bias risk and quality of the included research were evaluated.The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBiL)and alkaline phosphatase(ALP)before and after treatment were analyzed by Review manager 5.4 software,and the safety of intervention measures included in the study was evaluated.Search RCT,famous doctor's experience,medical records,etc.published in CNKI,Wanfang database and VIP database from self-built database to January 1,2021,extract data and establish prescription database,and carry out drug use frequency,taste and tropism,association rules,cluster analysis,etc.Results A total of 21 related studies were included in part of the study,including 5 high-quality studies.A total of 1971 patients were included in the study,including 1023 patients in the experimental group and 948 patients in the control group.Generally speaking,Chinese medicine is superior to western medicine in ALT,AST and TBiL,but has no obvious advantage in reducing ALP compared with western medicine.Subgroup analysis showed that most Chinese medicinal decoctions had certain advantages in protecting liver and reducing enzyme and bilirubin compared with conventional western medicine treatment,but some decoctions were inferior to western medicine in curative effect of outcome index,and failed to show obvious advantages.Chinese patent medicine has remarkable curative effect in protecting liver and reducing bilirubin,and it is superior to or equivalent to conventional western medicine treatment in terms of outcome index.In terms of safety,Chinese medicine decoction and Chinese patent medicine have no obvious adverse reactions,and have good safety.A total of 58 related studies were included in the second part of the study,including 53 prescriptions containing 121 traditional Chinese medicines.The results showed that the highest frequency of drug use was Bupleurum root(32 times),followed by Glycyrrhiza uralensis Fisch(28 times)and Artemisia capillaris(27 times).The drug properties were mainly cold,the drug tastes were mainly bitter and sweet,and the drug channels were mainly liver channels,lung channels,stomach channels and spleen channels,with many effects Association rule analysis showed that Bupleurum-Radix Paeoniae Alba,Bupleurum-Herba Artemisiae Scopariae-Glycyrrhrizae Radix,Herba Artemisiae Scopariae-Atractylodis Rhizoma-Glycyrrhrizae Radix,etc.were commonly used drug combinations for treating DILI.Cluster analysis showed that the effects of the seven groups of drugs were mainly soothing liver and invigorating spleen,clearing away heat and eliminating dampness,and promoting blood circulation and removing blood stasis.Conclusion Chinese medicine has good safety,among which Chinese patent medicine has good curative effect in treating DILI,has unique advantages in protecting liver and reducing enzyme,and is widely used in clinical practice.Most traditional Chinese medicine decoction is superior to or equivalent to western medicine routine in clinical curative effect,but some traditional Chinese medicine decoction fails to show advantages in protecting liver and reducing enzyme and bilirubin compared with western medicine routine.Because there are many traditional Chinese medicine interventions used to treat DILI,which are scattered and lack of syndrome differentiation and treatment,the results fail to fully reflect its use and actual clinical efficacy,and lack of popularization.Therefore,it is still necessary to carry out high-quality clinical research with large samples,multi-centers,rigorous methodology and characteristics of TCM syndrome differentiation around each intervention in the future,in order to obtain high-quality evidence-based medicine evidence.Combined with the results of the second study,the treatment mainly focuses on soothing the liver and invigorating the spleen,clearing heat and promoting diuresis,and the medication mainly focuses on the liver meridian.It can be seen that DILI mainly takes liver deficiency and spleen deficiency as its basic pathogenesis,and its disease location is in the liver and spleen,and its pathological products are damp-heat,qi stagnation and blood stasis.This study can provide new ideas and reference for clinical treatment of DILI,but it has not fully reflected the medication rule of Chinese medicine in treating DILI,and it is still necessary to use drugs according to the specific conditions of patients.