Herb-induced Liver Injury: An Updated Meta-analysis and Bibliometric Analysis

The global rise of herbal medicine as an alternative treatment has led to an increase in herb-induced liver injury (HILI). To examine this link and its clinical relevance, our meta-analysis and bibliometric analysis reviewed HILI cases reported in English literature. Our analysis identified 389 studies with 654 patients. We found a global increase in HILI reports, particularly between 2002 and 2011. Weight management was the most common reason for herbal use. Shou-Wu-Pian, Germander, Tinospora spp., Greater Celandine, and Mahuang were frequently implicated. Additionally, mixed herbal products consumption involved a higher risk of transplantation or death and shorter latency periods than single herbs. Females, accounting for 65.2% of cases, were often older at onset and with longer herb use, while males had a higher chance of having high Gamma Glutamyl Transferase (GGT) levels. Older age correlated with less severe injury but higher GGT, longer herb use, and latency. Race influenced International Normalized Ratio INR), Total bilirubin (TBL), and injury severity. Our study provides valuable insights for healthcare practitioners. Considering factors like gender, age, race, and usage patterns is essential for diagnosing and managing HILI.随着全球范围内草药作为替代疗法的兴起，草药诱导性肝损伤（Herb-Induced Liver Injury, HILI）的发生率呈逐年上升趋势。为探究该关联及其临床意义，本研究通过荟萃分析与文献计量分析，对英文文献中报道的HILI病例展开回顾性梳理。本次分析共纳入389项研究，涉及654例患者。研究发现，全球范围内HILI的报道病例数呈显著增长态势，尤其在2002年至2011年间增幅尤为突出。体重管理是使用者选择草药的最常见动因。首乌片（Shou-Wu-Pian）、吉玛德（Germander）、青牛胆属植物（Tinospora spp.）、白屈菜（Greater Celandine）以及麻黄（Mahuang）为最常被报道的致病草药。此外，与单一草药制剂相比，混合草药制剂的使用者发生肝移植或死亡的风险更高，且潜伏期更短。女性患者占总病例数的65.2%，其发病年龄普遍更高，且草药服用时长更长；而男性患者的γ-谷氨酰转移酶（Gamma Glutamyl Transferase, GGT）水平升高的概率显著更高。年龄更大的患者，其肝损伤程度往往更轻微，但GGT水平更高、草药服用时长及潜伏期更长。种族因素会影响国际标准化比值（International Normalized Ratio, INR）、总胆红素（Total Bilirubin, TBL）水平以及肝损伤严重程度。本研究为临床医护人员提供了极具价值的参考依据。在HILI的诊断与临床管理中，综合考量性别、年龄、种族及用药模式等相关因素，对提升诊疗质量至关重要。