title: Hepatobiliary and pancreatic: Comparison between Chinese herbal medicine and Western medicine-induced liver injury of 1985 patients.
abstract: OBJECTIVE
  Chinese herbal medicine (CHM), as well as Western medicine (WM), is an important cause of drug-induced liver injury (DILI). However, the differences between CHM and WM as agents implicated in liver injury have rarely been reported.
  
  
  METHODS
  Overall, 1985 (2.05%) DILI cases were retrospectively collected from the 96 857 patients hospitalized because of liver dysfunction in the 302 Military Hospital between January 2009 and January 2014.
  
  
  RESULTS
  In all the enrolled patients with DILI, CHM was implicated in 563 cases (28.4%), while 870 cases (43.8%) were caused by WM and the remaining patients (27.8%) by the combination of WM and CHM. Polygonum multiflorum was the major implicated CHM. Compared with WM, the cases caused by CHM showed more female (51 vs 71%, P < 0.001) and positive rechallenge (6.1 vs 8.9%, P = 0.046), a much greater proportion of hepatocellular injury (62.2 vs 88.5%, P < 0.001), and a higher mortality (2.8 vs 4.8%, P = 0.042); however, no differences in the rates of chronic DILI and ALF were found (12.9 vs 12.4%, P = 0.807; 7.6 vs 7.6%, P = 0.971). Based on Roussel Uclaf Causality Assessment Method, 75.6% of cases caused by CHM were classified as probable and only 16.6% as highly probable, significantly different from WM (38.4 and 60.3%, all P < 0.001).
  
  
  CONCLUSIONS
  The causal relationship between CHM and liver injury is much complex, and the clinical characteristics of DILI caused by CHM differ from those caused by WM.
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.|Integrative Medical Center, 302 Military Hospital, Beijing, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Niu
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.|Integrative Medical Center, 302 Military Hospital, Beijing, China.|Luhe Hospital of Tongzhou District, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Diagnosis and Treatment Center for Non-infectious Diseases, 302 Military Hospital, Beijing, China.
authors.forename: Zheng-Sheng
authors.initials: ZS
authors.lastname: Zou
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.|Beijing Friendship Hospital, Capital Medical University, Beijing, China.
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Ma
authors.affiliation: Department of Pathology, 302 Military Hospital, Beijing, China.
authors.forename: Shu-Hong
authors.initials: SH
authors.lastname: Liu
authors.affiliation: Department of traditional Chinese medicine, 302 Military Hospital, Beijing, China.
authors.forename: Rui-Lin
authors.initials: RL
authors.lastname: Wang
authors.affiliation: Integrative Medical Center, 302 Military Hospital, Beijing, China.
authors.forename: Ting-Ting
authors.initials: TT
authors.lastname: He
authors.affiliation: Center for Drug Reevaluation, China Food and Drug Administration, Beijing, China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Song
authors.affiliation: Integrative Medical Center, 302 Military Hospital, Beijing, China.
authors.forename: Zhong-Xia
authors.initials: ZX
authors.lastname: Wang
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.
authors.forename: Shi-Biao
authors.initials: SB
authors.lastname: Pu
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Ma
authors.affiliation: Integrative Medical Center, 302 Military Hospital, Beijing, China.
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Wang
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.
authors.forename: Zhao-Fang
authors.initials: ZF
authors.lastname: Bai
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Zhao
authors.affiliation: Department of traditional Chinese medicine, 302 Military Hospital, Beijing, China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Li
authors.affiliation: China Military Institute of Chinese Medicine, 302 Military Hospital, Beijing, China.
authors.forename: Jia-Bo
authors.initials: JB
authors.lastname: Wang
authors.affiliation: Integrative Medical Center, 302 Military Hospital, Beijing, China.
authors.forename: Xiao-He
authors.initials: XH
authors.lastname: Xiao
mesh_terms: D000328:Adult; D001660:Biliary Tract Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D004365:Drugs, Chinese Herbal
keywords: Chinese herbal medicine; causality assessment; drug-induced liver injury; prognosis