a Department of Gastroenterology , General Hospital of Shenyang Military Area , Shenyang , China.
b Postgraduate College , Liaoning University of Traditional Chinese Medicine , Shenyang , China.
Expert Rev Gastroenterol Hepatol. 2018 Apr;12(4):425-434. doi: 10.1080/17474124.2018.1427581. Epub 2018 Jan 18.
Traditional Chinese medicine (TCM) is becoming increasingly popular and related adverse events are often ignored or underestimated.
This systematic review aimed to evaluate the clinical characteristics and outcomes of TCM-induced liver injury (TCM-ILI) and to estimate the proportion of TCM-ILI in all drug-induced liver injuries (DILI).
China National Knowledge Infrastructure, Wanfang, VIP, PubMed, and Embase databases were searched. Demographic, clinical, and survival data were extracted and pooled. Factors associated with worse outcomes were calculated. For the proportion meta-analyses, the data were pooled by using a random-effects model.
Overall, 21,027 articles were retrieved, of which 625 were finally included. There was a predominance of female and older patients. The proportion of liver transplantation was 2.18% (7/321). The mortality was 4.67% (15/321). Male, higher aspartate aminotransferase and direct bilirubin, and lower albumin were significantly associated with an increased risk of death/liver transplantation in TCM-ILI patients. The proportion of TCM-ILI in all DILI was 25.71%. The proportion was gradually increased with year.
Our work summarises current knowledge regarding clinical presentation, disease course, and prognosis of TCM-ILI. TCM can result in hepatotoxicity, even death or necessitate life-saving liver transplantation. Governmental regulation of TCM products should be strictly established.
中医药（TCM）越来越受欢迎，相关的不良事件经常被忽视或低估。
本系统评价旨在评估中药相关肝损伤（TCM-ILI）的临床特征和结局，并估计 TCM-ILI 在所有药物性肝损伤（DILI）中的比例。
检索中国知网、万方、VIP、PubMed 和 Embase 数据库。提取人口统计学、临床和生存数据，并进行汇总。计算与不良结局相关的因素。对于比例的荟萃分析，采用随机效应模型对数据进行汇总。
共检索到 21027 篇文章，最终纳入 625 篇。患者以女性和老年人为主。肝移植比例为 2.18%（7/321）。死亡率为 4.67%（15/321）。男性、较高的天门冬氨酸转氨酶和直接胆红素，以及较低的白蛋白与 TCM-ILI 患者死亡/肝移植风险增加显著相关。TCM-ILI 在所有 DILI 中的比例为 25.71%。该比例随年份逐渐增加。
本研究总结了 TCM-ILI 的临床表现、病程和预后的现有知识。TCM 可导致肝毒性，甚至死亡或需要进行挽救生命的肝移植。应严格建立 TCM 产品的政府监管。
