Glycyrrhizic Acid CAS 1405-86-3

The treatment of chronic hepatitis B (CHB) and chronic hepatitis C (CHC) in viral hepatitis should focus on the antiviral treatment for the cause, but for patients whose cause has not been completely controlled or is temporarily unsuitable for antiviral treatment In the case of liver inflammation, anti-inflammatory and hepatoprotective drugs are appropriately selected.

Recommendation 1: Glycyrrhizic acid preparations can be used for patients with viral hepatitis with abnormal liver function, and can also be used in combination with antiviral drugs for CHB and CHC patients with abnormal liver function (A1). Those with severe inflammation can be switched to oral dosage form for sequential treatment for 4-12 weeks after treatment with injection dosage form (C1).

n recent years, with the increase of drug types and the continuous emergence of new drugs, the incidence of drug-induced liver injury (DILI) has increased significantly. In developed countries such as the United States and Western Europe, acetaminophen is the main cause of acute liver failure. A retrospective Meta-analysis of the causes of DILI in my country from 1999 to 2012 showed that the main causes of DILI in my country after 2006 evolved into Chinese herbal medicine (30.38%), anti-tuberculosis drugs (20.57%), antibacterial drugs (11.49%) and anti-tumor drugs (10.26%). Timely discontinuation of suspicious drugs is the most important treatment for DILI, and hepatoprotective drugs can be appropriately selected for patients with severe inflammation.

Recommendation 2: For patients with drug-induced liver injury, it is recommended to use glycyrrhizic acid preparations for liver protection and anti-inflammatory treatment on the basis of timely discontinuation of drugs that cause liver injury (A1).

The pathogenesis of alcoholic liver disease (ALD) is related to free radical damage, lipid metabolism disorder and oxidative stress. The main treatment is etiological treatment (alcohol abstinence). On this basis, the application of glycyrrhizic acid can improve the liver Biochemical Indicators.

Recommendation 3: For patients with alcoholic liver disease, the etiological treatment (abstinence) should be emphasized. On this basis, there are still repeated abnormal liver function, liver tissue examination confirmed obvious inflammation and fibrosis, or the disease has progressed significantly, glycyrrhizic acid can be used. Preparation for anti-inflammatory liver protection therapy (B2).

Although Chinese guidelines currently do not recommend the routine use of hepatoprotective drugs for NAFLD/NASH patients, it points out that under the premise of basic treatment, hepatoprotective drugs such as glycyrrhizic acid can be used as adjuvant therapy for: ① NASH patients diagnosed by liver histology; ② Clinical and experimental Laboratory examinations suggest that there may be obvious liver damage and/or progressive liver fibrosis; ③ Those who intend to use other drugs that may or have caused liver damage will affect the implementation of the basic treatment plan; ④ Combined with hepatotropic virus infection or other liver disease. The course of treatment usually takes more than 6-12 months.

Recommendation 4: For patients with non-alcoholic fatty liver disease, basic treatments such as lifestyle changes, weight control, improvement of insulin resistance, and correction of metabolic disorders should be emphasized, but ALT, AST, and GGT are still elevated, and liver tissue examination confirms that the course of the disease is chronic. For those who progress, glycyrrhizic acid preparations can be used for anti-inflammatory and hepatoprotective treatment (B2).

Glycyrrhizic acid preparation has a certain value in the treatment of autoimmune hepatitis (AIH) in addition to its general hepatoprotective effect in the treatment of autoimmune liver disease. AIH is an inflammatory lesion of the liver characterized by hyperglobulinemia, multiple autoantibodies, and pathologically with debris-like necrosis in the portal area. At present, the relevant guidelines recommend that the standard treatment regimen for AIH is glucocorticoid ± immunosuppressive agents, but clinically, a considerable number of AIH patients are not suitable for the use of glucocorticoids and Immunosuppressants. Glycyrrhizic acid preparations have certain value in the treatment of such AIH patients due to their anti-inflammatory, regulation of excessive immunity in the liver and steroid-like effects.

Recommendation 5: Glycyrrhizic acid preparations can be used for the adjuvant treatment of AIH patients, especially for patients with contraindications to hormones ± immunosuppressants, the application of glycyrrhizic acid preparations as much as possible can be considered to improve the biochemical indicators of patients (B2).

Glycyrrhizic acid preparations can alleviate liver fibrosis by improving liver inflammation through its anti-inflammatory effect. A number of in vitro experiments and animal model studies have shown that glycyrrhizic acid preparations can act on signaling pathways such as TGF-β1/Smad to inhibit liver fibrosis.

Recommendation 6: Patients with liver cirrhosis and liver cancer with abnormal liver function can be treated with glycyrrhizic acid preparations for liver protection and anti-inflammatory treatment (B2). During the treatment, attention should be paid to the monitoring of adverse reactions such as electrolyte disturbance (C2).

Liver failure is a serious liver damage caused by a variety of factors, resulting in severe impairment or decompensation of liver synthesis, detoxification, excretion, and biotransformation, mainly including coagulation dysfunction, jaundice, hepatic encephalopathy, and ascites. A group of clinical syndromes manifested, divided into four types: acute, subacute, acute-on-chronic and chronic liver failure. At present, there is still a lack of specific drugs and means for medical treatment. Corresponding etiological treatment and comprehensive treatment measures are mainly adopted for different etiologies. Basic research has confirmed that compound glycyrrhizin can reduce hepatocyte apoptosis, restore degenerated hepatocytes, and protect uninjured hepatocytes in mice with fulminant liver failure, thereby reducing the mortality rate.

Recommendation 7: Glycyrrhizic acid preparations have anti-inflammatory and improve liver function. It is recommended that patients with liver failure should use glycyrrhizic acid preparations on the basis of etiological treatment and comprehensive supportive treatment (B1).