To explore the clinical and pathological characteristics of Polygonum multiflorum-associated liver injury.

Medical record data of inpatients with Polygonum multiflorum-associated liver injury diagnosed by histopathological examination between January 2009 and December 2018 in Beijing Ditan Hospital, Capital Medical University were collected and analyzed retrospectively. According to the different processing methods of Polygonum multiflorum, the patients were divided into raw Polygonum multiflorum group and prepared Polygonum multiflorum group. The clinical and pathological characteristics in patients in the 2 groups were compared.

A total of 22 patients entered the study. Of them, 8 patients were in the raw Polygonum multiflorum group, including 4 males and 4 females with a median age of 32 (25, 37) years; 14 patients were in the prepared Polygonum multiflorum group, including 2 males and 12 females with a median age of 51 (38, 58) years. Twenty one patients were clinically identified as hepatocellular injury type and one patient (raw Polygonum multiflorum group) was identified as mixed type, which all had varying degrees of acute hepatitis related symptoms. The median peak levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin in the raw Polygonum multiflorum group were significantly higher than those in the prepared Polygonum multiflorum group [1 832 (1 134, 2 301) U/L vs. 900 (456, 1 102) U/L, P=0.001; 1 135 (475, 1 408) U/L vs. 466 (240, 662) U/L, P=0.017; 212.1 (102.5, 363.4) μmol/L vs. 59.7 (17.7, 117.3) μmol/L, P=0.012]. The main pathological manifestation of liver injury in patients in the 2 groups was acute lobular hepatitis. After the occurrence of liver injury, all 22 patients discontinued Polygonum multiflorum preparation and were given symptomatic treatment, and all were improved and discharged after 9-37 d of hospitalization. After discharge, one patient lost the follow-up and the other 21 patients′ liver function recovered, with a median time to recovery of 3 (2, 6) months. Three patients′ abnormal liver function lasted more than 6 months and they were diagnosed with chronic hepatitis.

Polygonum multiflorum-associated liver injury is mainly hepatocellular injury type and the pathological feature is acute lobular hepatitis. The degree of liver injury caused by raw Polygonum multiflorum is more serious than that caused by prepared Polygonum multiflorum. After stopping Polygonum multiflorum and giving symptomatic treatment, most patients had a good prognosis.

Chemical and drug induced liver injury; Drugs, Chinese herbal; Fallopia multiflora