Systematic Review and Meta-Analysis of Hugan Tablets(护肝片)in the Treatment of Drug-Induced Liver Injury

Objective:To systematically evaluate the efficacy and safety of Hugan Tablets(护肝片)in the treatment of drug-induced liver injury.Methods:Totally seven Chinese and English databases,including CNKI,Wanfang,VIP,CBM,PubMed,EMbase,Web of Science were searched for randomized controlled trials(RCTs)of Hugan Tablets(护肝片)for the treatment of drug-induced liver injury,which were published from the date of establishment to April 20,2019.The meta-analysis software RevMan 5.3 software and Excel were used to build a database into combine and analyze the studies that met the standards and to draw a forest plot.Results:Forty five RCTs were included with 7478 patients.The quality of included studies was uneven.Meta-analysis showed that the outcome index of liver injury rate was divided into seven subgroups.Hugan Tablets(护肝片)were used in the treatment of anti-tuberculosis drugs was superior to the conventional western medicine treatment group(RR=0.27,95%CI[0.22,0.33],P<0.00001).Which was also better than the without Hugan Tablets(护肝片)treatment group(RR=0.32,95%CI[0.20,0.52],P<0.00001).For the role of drug-induced liver injury in the treatment of type 2 diabetes,the Hugan Tablet+conventional treatment group is better than the conventional treatment group(RR=0.16,95%CI[0.03,0.88],P=0.03).The effect of drug-induced liver injury in the treatment of hypertension was superior to the conventional western medicine treatment group(RR=0.07,95%CI[0.03,0.14],P<0.00001).The effect of drug-induced liver injury during the treatment of hyperlipidemia was not statistically significant(RR=0.57,95%CI[0.33,1.00],P=0.05).There was no statistical difference between the two groups in the effect of drug-induced liver injury during the treatment of coronary heart disease(RR=0.09,95%CI[0.01,1.61],P=0.10).There was no significant difference between the two groups in the treatment of cerebral thrombosis for drug-induced liver injury(RR=0.11,95%CI[0.01,2.01],P=0.14).The effect of anti-hyperthyroidism on liver injury was better than that of conventional western medicine treatment group(RR=0.45,95%CI[0.25,0.82],P=0.009).Outcome index of total effective rate was divided into two subgroups.The effect of drug-induced liver injury caused by the type of drug was not mentioned was superior to the conventional western medicine treatment group(RR=0.78,95%CI[0.70,0.88],P<0.0001).There was no significant difference between the two groups in the liver injury caused by antipsychotic drugs(RR=0.97,95%CI[0.81,1.16],P=0.72).Conclusion:When used in the treatment of tuberculosis and psychiatric drug treatment,combineduse of Hugan Tablets(护肝片)can significantly reduce the incidence of drug-induced liver damage,and can significantly improve clinical symptoms caused by liver damage.In the treatment of hypertension,the addition of Hugan Tablets(护肝片)can significantly reduce the incidence of drug-induced liver injury,improving the safety of medication.In the treatment of drug-induced liver injury caused by which drug is not mentioned,Hugan Tablet has a therapeutic effect.Slight adverse reactions were reported,including rash,headache,palpitations,hypoglycemia,flushing,fatigue,nausea,bowel sounds,flatulence,diarrhea,and gastrointestinal discomfort.All studies reported minor adverse reactions that were well tolerated by patients and recovered without treatment after discontinuation.Oral administration of Hugan Tablets(护肝片)has positive effects on druginduced liver injury,but this conclusion still needs further evidences delete.It is necessary to adopt a larger sample,more design,and accord with the international standards to improve the quality of evidence.     

四君子汤合血府逐瘀汤对利血平胃溃疡模型小鼠胃黏膜、胃组织SOD、MDA、NO及气、血、阴盛衰影响随机平行对照研究

[目的]观测四君子汤合血府逐瘀汤对利血平胃溃疡模型小鼠胃黏膜、胃组织SOD、MDA、NO及气、血、阴盛衰影响。[方法]使用随机平行对照方法,将40只昆明种小鼠按按随机数字表分为4组,空白对照组、模型组、奥美拉唑组、中药复方组,10只/组。参照利血平胃溃疡模型小鼠制备方法复制胃溃疡模型,实验第8d除空白对照组外,3组均皮下注射利血平0.1mg/10g。实验第9d药物干预,奥美拉唑组腹腔注射,中药复方组四君子汤合血府逐瘀汤灌胃干预,连续5d,1次/d。行旷场试验,抓力检测,并测定爪/尾r值,计算各组小鼠气、血和阴盛衰,检测胃黏膜、胃组织SOD、MDA、NO含量。[结果]实验第13d模型组胃黏膜多见较大面积溃疡。气、血、阴盛衰度:实验第7d各组均无显著差异(P0.05),实验第9d模型组、奥美拉唑组、中药复方组均低于空白对照组(P0.01),实验第13d(干预第5d)中药复方组与奥美拉唑组干预组均改善(P0.01,P0.05),组间无显著差异(P0.05)。溃疡指数:实验第13d(药物干预第5d)奥美拉唑组、中药复方组均低于模型组(P0.01),中药复方组与奥美拉唑组无显著差异(P0.05)。SOD、MDA、NO:实验第13d,SOD模型组、中药复方组均低于空白对照组(P0.01),奥美拉唑组与空白对照组无显著差异(P0.05),奥美拉唑组、中药复方组均高于模型组(P0.01),中药复方组低于奥美拉唑组(P0.01);MDA模型组、奥美拉唑组、中药复方组均高于空白对照组(P0.01),奥美拉唑组、中药复方组均低于模型组(P0.01),中药复方组高于奥美拉唑组(P0.01);NO模型组、奥美拉唑组、中药复方组均低于空白对照组(P0.01),奥美拉唑组低于模型组(P0.01),中药复方组与模型组、奥美拉唑组无显著差异(P0.05)。[结论]四君子汤合血府逐瘀汤可改善利血平胃溃疡模型小鼠气血两虚,降低溃疡指数,提高溃疡抑制率,增加组织SOD活力与NO含量,降低MDA含量。