2026 Volume 28 Issue 2 Published: 28 February 2026
  

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  • Expert consensus on standardized prescribing and rational use of external preparations in medical institutions (2026 edition)
    Beijing Pharmaceutical Association Primary Care Pharmacy Committee, Beijing Pharmacy Center for Quality Control and Improvement
    2026, 28(2): 73-78. https://doi.org/10.3760/cma.j.cn114015-20250726-00393
    Abstract ( ) PDF ( )
    External preparations have advantages including direct therapeutic action, high local drug concentrations, and minimal systemic adverse reactions, representing an important therapeutic modality for various diseases. However, current clinical application standards for external preparations remain substantially suboptimal, posing considerable medication safety risks. To establish dosage specifications and combination therapy strategies for external preparations and promote their safe and rational use, the Beijing Pharmaceutical Association Primary Care Pharmacy Committee and Beijing Pharmacy Center for Quality Control and Improvement convened clinical and pharmaceutical experts from 27 medical institutions in Beijing and developed the "Expert consensus on standardized prescribing and rational use of external preparations in medical institutions (2026 edition)", based on current evidence-based medical data, experience of multidisciplinary experts in frontline clinical practice, and the patients′ rational use requirements for topical preparations. The expert consensus addresses 7 clinical questions across 3 medication scenarios and provides specific recommendations and the recommendation strengths for each scenario, including monotherapy of one external preparation, combination therapy of external preparation with its systemic preparation, and combination therapy with 2 or more external preparations. It is published with the aim to promote rational drug use of external preparations and reduce the occurrence of adverse drug reactions.
  • Construction of a predictive model based on machine learning for the efficacy of triple antiemetic regimen in preventing nausea and vomiting induced by cisplatin chemotherapy
    Zhang Jingyue, Yang Chong, Lan Gaoshuang, Sun Yinjuan, Zhang Hanxu, Li Yun, Zhang Linlin, Yuan Hengjie
    2026, 28(2): 79-86. https://doi.org/10.3760/cma.j.cn114015-20250508-00247
    Abstract ( ) PDF ( )
    Objective To establish a predictive model for the efficacy of the antiemetic regimen with neurokinin-1 receptor antagonist, 5-hydroxytryptamine 3 receptor antagonist, and dexamethasone (abbreviated as triple antiemetic regimen) in preventing chemotherapy-induced nausea and vomiting (CINV) in tumor patients undergoing cisplatin chemotherapy based on machine learning, and to provide a basis for the selection of antiemetic regimens in clinic.　Methods Tumor patients who received cisplatin chemotherapy and used the triple antiemetic regimen at the Department of Oncology, Tianjin Medical University General Hospital from January 2018 to December 2022 were entered. Clinical information was collected via the hospital information system, including patient age, gender, tumor type, history of pregnancy-related nausea, and laboratory tests results before chemotherapy, etc. After pre-processing, the data were stratified and randomly divided into the training set and the validation set at a ratio of 8∶2. The predictive model was constructed based on the training set, using five algorithms of categorical boosting, deep forest (gcForest), support vector machine, random forest and decision tree. The model′s performance was evaluated based on the validation set. The Shapley Additive exPlanation (SHAP) value was used to analyze the features from the global and local levels.　Results A total of 379 patients were entered, including 261 males (68.9%), with a median age of 63 years. These patients received 731 cycles of chemotherapy in total, and CINV occurred after 114 cycles (15.6%) of chemotherapy. Twenty-four variables were identified using the least absolute shrinkage and selection operator regression analysis. The constructed five models all had good predictive performance in the training set, and the gcForest model had the best in the validation set, showing area under the receiver operating characteristic curve 0.872, accuracy 0.850, precision 0.739, recall 0.840, F1 score 0.770, and Brier score 0.090. The difference between the indicators of gcForest model in the training set and the validation set was minor, and the prediction performance was stable. The SHAP analysis revealed that creatinine clearance (Ccr), gender, age, expected nausea and vomiting, and globulin level were the main features for model prediction. Effectiveness of the triple antiemetic regimen increased with higher Ccr, and age and decreased with higher globulin level; its effectiveness reduced in female patients and patients with expectation of nausea and vomiting .　Conclusions The model based on the gcForest algorithm and incorporating metabolism-related features such as Ccr had shown good performance in predicting the effectiveness of triple antiemetic regimens for prevention of cisplatin-induced CINV. It could provide auxiliary support for individualized risk stratification and antiemetic regimen selection in patients.
  • Screening of potential biomarkers for drug-induced liver injury based on HP-CIL LC-MS metabolomics technology
    Wei Xianni, Wei Jinbao, Xie Genying, Liu Jie, Wu Wenjing, Lian Siheng
    2026, 28(2): 87-94. https://doi.org/10.3760/cma.j.cn114015-20250429-00234-1
    Abstract ( ) PDF ( )
    Objective To study the metabonomics of drug-induced liver injury (DILI) by high performance-chemical isotope labeling chromatography-mass spectrometry (HP-CIL LC-MS) and screen potential serum biomarkers of DILI.　Methods Serum samples were collected from 38 patients with DILI (DILI group) and 20 patients without DILI (control group). The serum metabolites in patients of the 2 groups were detected by HP-CIL LC-MS and analyzed through 3 methods. Firstly, principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) were used for multivariate statistical analysis on differential metabolites, and the primary and secondary metabolites with variable importance for the projection (VIP)>1 and VIP ranking in the top 20 were screened. Secondly, univariate statistical analysis was used to analyze the differences of all metabolites detected, and the top 10 metabolites with significant differences were selected, respectively from the up-regulated and down-regulated metabolites. Thirdly, the receiver operating characteristic (ROC) curves of serum metabolites in patients of the 2 groups were drawn, and the top 10 primary and secondary metabolites ranked by the area under the curve (AUC) were selected. The metabolites detected by at least 2 of the above methods were identified as potential biomarkers of DILI. The primary and secondary differential metabolites obtained from univariate statistical analysis were subjected to metabolic pathway enrichment analysis.　Results The base peak chromatograms of ion intensity of serum metabolites obtained by HP-CIL LC-MS in positive ion mode showed good peak shapes and good separation of metabolites in patients of the DILI group and control group. Through multivariate statistical analysis, univariate statistical analysis and ROC curve analysis, 8 potential biomarkers of DILI were detected from the differential serum metabolites in patients of the DILI group and control group, including phenylalanyl-tryptophan, 2-(3-carboxy-3-aminopropyl)-L-histidine, O-methyl-L-threonine, dTDP-4-amino-4,6-dideoxy-5-C-me- thyl-D-aldose, S-cysteinosuccinic acid, phenylalanyl-glutamic acid, allocystathionine, and N8-acetyl-spermidine. Pathway analysis showed that these metabolites were significantly enriched in amino acid metabolism- related pathways, mainly including metabolic pathways of tryptophan, tyrosine, cysteine and methionine, and biosynthesis pathways of phenylalanine, tyrosine and tryptophan.　Conclusions Metabolomic analysis based on HP-CIL LC-MS can effectively distinguish the serum metabolic profiles of DILI patients from those of patients without DILI, and several potential biomarkers of DILI have been identified. These metabolites are mainly involved in amino acid metabolic pathways, and the clinical significance needs further researches.
  • Efficacy, safety and economy of inclisiran in the treatment of hypercholesterolemia: a rapid health technology assessment
    Zhou Yang, Saifeiya·Saiwaidu, Peng Wenxing, Lin Yang, Shi Xiujin
    2026, 28(2): 95-102. https://doi.org/10.3760/cma.j.cn114015-20250703-00351
    Abstract ( ) PDF ( )
    Objective To evaluate the efficacy, safety, and economy of inclisiran in the treatment of hypercholesterolemia, providing evidence-based support for rational clinical use and health insurance decision-making.　Methods Rapid health technology assessment (HTA) approach was adopted. The relevant websites and databases were systematically searched to collect the systematic reviews/meta-analysis, pharmacoeconomic research and HTA reports on the treatment of hypercholesterolemia with inclisiran. The retrieval time was from the establishment of the databases to May 9, 2025. The included literature was evaluated for quality using the HTA checklist, a measurement tool to assess systematic reviews 2 scale, and consolidated health economic evaluation reporting standards 2022-scale, and a qualitative comprehensive comparison and analysis were conducted on efficacy, safety, and cost-effectiveness.　Results A total of 23 literature were enrolled in the study, including 15-systematic reviews/meta-analyses (14 of which were of high-quality and 1 of which was of medium-quality), 5 pharmacoeconomic studies (all of which were of high-quality) and 3 HTA reports (all of which were of high-quality). The results of effectiveness study showed that compared with placebo or other lipid-lowering treatments (the control group), the levels of low-density lipoprotein cholesterol, proprotein convertase subtilisin/kexin type 9, lipoprotein α， total cholesterol, non- high-density lipoprotein cholesterol and apolipoprotein B were significantly decreased, and the level of high-density lipoprotein cholesterol was increased in the inclisiran group, the differences were statistically significant (all P<0.05). However, there was no significant difference in reducing the risk of major adverse cardiovascular events, cardiovascular mortality, all-cause mortality, myocardial infarction, and stroke between the 2 groups (all P>0.05). The results of studies on medication safety showed that, except for a higher incidence of adverse reactions at the injection site in the inclisiran group than that in the control group, there was no significant difference in the incidence of other adverse reactions between the 2 groups (all P>0.05).The results of research on economics showed that the economic performance of inclisiran varied due to differences in the region, price, and population characteristics.　Conclusions Inclisiran has good efficacy and safety in the management of hypercholesterolemia. For high-risk patients with atherosclerotic cardiovascular disease who fail to achieve lipid targets despite standard lipid-lowering therapy, inclisiran has a certain economic value.
  • Analysis on clinical characteristics of pembrolizumab-induced immune-mediated encephalitis
    Miao Qiuli, Liu Yang, Wang Haiying, Li Tingyu
    2026, 28(2): 103-108. https://doi.org/10.3760/cma.j.cn114015-20250415-00201
    Abstract ( ) PDF ( ) Supplementary files
    Objective To explore the clinical characteristics of pembrolizumab-induced immune- mediated encephalitis (IME) and provide reference for clinical medication safety.　Methods Domestic and international databases were searched (up to December 31, 2024), and case reports on pembrolizumab- related IME were collected. Data on patient basic information, pembrolizumab use, time to IME onset, and the clinical manifestations, auxiliary examinations, treatments and outcomes of IME were extracted for descriptive statistical analysis.　Results A total of 21 articles involving 21 patients were included. There were 15 males and 6 females, aged 64 (56, 71) years with a range of 47-80 years. Primary diseases included lung cancer in 9 patients, melanoma in 6 patients, and myxoid chondrosarcoma, nasal angiosarcoma, thyroid cancer, bladder cancer, renal cell carcinoma, and uterine cancer in 1 patient each. Twenty patients received pembrolizumab monotherapy, and 1 received the drug combined with paclitaxel (albumin-bound). The time from pembrolizumab initiation to IME onset was recorded in 20 cases, which was 147 (90, 267) days with a range from 21 to 360 days. Main clinical manifestations of IME included cognitive impairment (12 cases), motor/sensory deficits (9 cases), psychiatric/behavioral abnormalities (7 cases), consciousness disturbance (7 cases), epileptic seizures (6 cases), and autonomic dysfunction (2 cases). Regarding the auxiliary examinations, abnormal electroencephalogram accounted for 10/11; abnormal cerebrospinal fluid analysis accounted for 14/16, mainly characterized by elevated protein and increased lymphocyte/white blood cell counts; abnormal cranial MRI accounted for 50.0% (10/20), and the abnormal signals were frequently observed in the temporal lobe (hippocampal) or white matter/subcortical regions. After IME onset, 18 patients received glucocorticoid therapy, 5 of whom also received human immunoglobulin and 2 received additional plasma exchange; the other 3 patients were treated solely with human immunoglobulin, an antipsychotic agent (aripiprazole), and an antiepileptic regimen (sequential therapy with levetiracetam and valproate), respectively. Pembrolizumab was discontinued in 19 patients. Of them, the condition was improved in 16 patients, remained stable in 2 patients, and was not improved in 1 patient (died later). The other 2 patients did not stop pembrolizumab and both showed clinical improvement in IME, however, one of them subsequently died due to acute massive cerebral infarction complicated by hemorrhage.　Conclusion Clinical manifestations and auxiliary examinations of pembrolizumab-induced IME lack specificity. Most patients have a favorable prognosis after discontinuation of pembrolizumab and treatments with glucocorticoids and/or human immunoglobulin. Making decision on whether to continue pembrolizumab or not requires an individualized evaluation of the patient′s specific condition.
  • Cost-effectiveness of genetic testing in preventing drug-related severe cutaneous adverse reactions: a meta-analysis
    Guo Kexin, Jing Shenao, Li Chenghao, Zhao Xinyue, Qiu Shengnan, Huang Xin
    2026, 28(2): 109-116. https://doi.org/10.3760/cma.j.cn114015-20250403-00179
    Abstract ( ) PDF ( )
    Objective To systematically evaluate the cost-effectiveness of genetic testing in preventing drug-related severe cutaneous adverse reactions (SCARs).　Methods CNKI, Wanfang, VIP, PubMed, Embase, Web of Science and Cochrane Library databases were searched by computer (up to January 20, 2025). The literature on the cost-effectiveness of genetic testing to prevent SCARs at home and abroad was collected. The quality of the included literature was evaluated using the Health Economic Evaluation Reporting Standards 2022. Data such as the first author, publication time, country, currency, willingness to pay threshold, discount rate, perspective, time range, model, incremental cost effectiveness ratio was extracted. Meta analysis was performed using Stata/SE 18.0-software, and subgroup analysis was conducted according to drug category. The effect size was expressed by the incremental net benefit (INB) and its 95% confidence interval (CI).　Results A total of 14-studies were included, involving 2 drugs. Eight studies were related to allopurinol and 6 were related to carbamazepine. The literature all had good quality, but there was a moderate risk of bias. Meta analysis showed that genetic testing did not show significant cost-effectiveness as a whole compared with conventional treatment management without genetic screening (INB=-10.14 dollars, 95%CI: -111.60-91.32 dollars). Subgroup analysis showed that SCAR risk gene testing related to carbamazepine had good cost utility (INB=342.79 dollars, 95%CI: -52.63-738.22 dollars), while that related to allopurinol was not economical (INB=-66.66 dollars, 95%CI: -180.52-47.20 dollars).　Conclusions The current researches on the cost-effectiveness of genetic testing in preventing drug-related SCAR focus on allopurinol and carba- mazepine. Gene screening for carbamazepine-related risks has clinical and economic feasibility, while that for allopurinol-related risk needs to be further weighed on the cost and benefit.
  • Progress in the association of glutathione S-transferase P1 gene polymorphisms with myelosuppression caused by platinum drugs
    Li Anan, Zhou Penglin, Gao Rui, Zong Huiying, Li Yan
    2026, 28(2): 117-122. https://doi.org/10.3760/cma.j.cn114015-20250217-00072
    Abstract ( ) PDF ( )
    Platinum drugs are fundamental medication in various chemotherapy regimens for malignant tumors. However, the high incidence of myelosuppression induced by platinum drugs often affects the therapeutic efficacy and reduces the life quality of patients. Glutathione S-transferase P1 (GSTP1), as a key enzyme in the metabolic pathway of platinum drugs, its gene polymorphism is considered as an important genetic factor leading to individual differences in drug toxicity. Studies have shown that patients carrying the G allele (AG/GG type) may have an increased risk of myelosuppression after chemotherapy with platinum drugs, and the toxicity profile shows drug specificity: carboplatin is more likely to cause thrombocytopenia, while cisplatin is more closely related to neutropenia and cumulative anemia. However, in studies targeting different populations, tumor types, and chemotherapy regimens, the above-mentioned associations vary. This article systematically reviews the research progress on the correlation between polymorphism of the GSTP1 gene and the myelosuppression caused by platinum drugs, aiming to provide references for the individualized application of platinum drugs in clinical practice and the early warning, prevention, and treatment of myelosuppression.
  • Research progress of decreased blood pressure related to glucagon-like peptide-1 receptor agonists
    Liang Jia, Shi Qianqian, Ma Yuan, Li Hongjuan, Ren Xiuli, Lu Cuicui
    2026, 28(2): 123-129. https://doi.org/10.3760/cma.j.cn114015-20250326-00165
    Abstract ( ) PDF ( )
    Glucagon-like peptide-1 receptor agonists (GLP-1RA) can mimic the effects of endo- genous incretin. In addition to effectively reducing blood glucose and promoting weight loss, its role in reducing blood pressure has also attracted increasing attention. Some studies have shown that GLP-1RA can reduce blood pressure, presenting a greater reduction in systolic blood pressure than that in diastolic blood pressure. The antihypertensive effect of different types of GLP-1RA is different. The antihypertensive effect of ultra- long-acting and long-acting preparations is usually better than that of short-acting preparations. The antihypertensive effect of GLP-1RA is dose-dependent, and the decrease in blood pressure is the largest at the initial stage (the first 2 weeks), and then gradually becomes slower. The mechanism by which GLP-1RA reduces blood pressure may be related to direct vasodilation, decreased sympathetic nervous system activity, increased urinary sodium excretion, and weight loss. This article reviews the characteristics, mechanisms, and influencing factors of different GLP-1RA in regulating blood pressure, aiming to provide guidance for the rational use of GLP-1RA and optimize the comprehensive management of patients with type 2 diabetes.
  • Pharmaceutical care of severe hypokalemia caused by abemaciclib
    Qian Jiajia, Ruan Cong, Li Gang, Ye Ling, Liu Jiyong, Xu Rui
    2026, 28(2): 130-132. https://doi.org/10.3760/cma.j.cn114015-20250417-00205
    Abstract ( ) PDF ( )
    A 56-year-old female patient with hyperlipidemia who had been treated with atorva- statin calcium for a long time was treated with abemaciclib (150 mg, twice daily), a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor, combined with letrozole (2.5 mg, once daily) for advanced breast cancer. A clinical pharmacist participated in the monitoring and management of adverse drug reactions (ADRs) throughout the course of treatment. A total of 4 ADRs that were either related or potentially related to abemaciclib were observed, including diarrhea (grade 1), anemia (grade 3), neutropenia (grade 3), and hypokalemia (grade 3, minimum blood potassium concentration 2.64 mmol/L). Diarrhea, anemia, and neutropenia were documented as common adverse events in the abemaciclib prescribing information, which supported a well-established causal association of above ADRs with the drug. After reviewing literature, the pharmacist found that the incidence of hypokalemia during the treatment of abemaciclib was reported in 3 clinical trials of abema- ciclib, and the incidence was 21.1%-29.3%. Additionally, case reports on potential drug-drug interactions between CDK4/6 inhibitors and statins were found. Considering that the patient′s hypokalemia might be related to abemaciclib and the interaction between abemaciclib and atorvastatin calcium could not be ruled out, it was suggested to temporarily stop abemaciclib and atorvastatin calcium. The patient′s serum potassium rose to 3.82 mmol/L on the 9th day after drug withdrawal. One month later, abemaciclib was restarted at a reduced dose (100 mg, twice daily), and the hypolipidemic drugs was changed to fenofibrate. The patient was followed up for 1 year, and no hypokalemia occurred again.
  • Rhabdomyolysis caused by the interaction of voriconazole and nirmatrelvir/ritonavir
    Liu Yiming, Wang Dongxue, Hou Jiqiu
    2026, 28(2): 133-135. https://doi.org/10.3760/cma.j.cn114015-20250401-00174
    Abstract ( ) PDF ( )
    A 71-year-old female patient received antiviral therapy with nirmatrelvir/ritonavir (Paxlovid, 300 mg/100 mg orally twice daily for 5 days) and antifungal therapy with voriconazole (400 mg/d orally for 5 days, 200 mg by intravenous infusion, once every 12 hours for 5 days) for coronavirus disease 2019 related pulmonary aspergillosis. Then the patient developed generalized muscle weakness accompanied by muscle soreness. Laboratory tests showed creatine kinase (CK) 1 452 U/L, CK-MB 31.9 μg/L, lactate dehydrogenase 330 U/L, and myoglobin 2 289.7 μg/L. Rhabdomyolysis was considered, which may be related to the interaction between voriconazole and Paxlovid. Subsequently, voriconazole was stopped and replaced by caspofungin to continue antifungal treatment. After discontinuing voriconazole for 3 days, laboratory tests showed CK 1 062 U/L, CK-MB 23.8 μg/L, and myoglobin 1 482.2 μg/L. After discontinuing voriconazole for 12 days, the patient′s symptoms such as general weakness and muscle soreness disappeared, and laboratory tests showed CK 94 U/L, CK-MB 5.8-μg/L, and myoglobin 75-μg/L.
  • Small intestine diaphragm disease caused by long-term use of etoricoxib
    Zhang Zhen, Li Shengcai, Tang Xiaoyong, Li Yanlong, Guo Jun
    2026, 28(2): 136-138. https://doi.org/10.3760/cma.j.cn114015-20250311-00134
    Abstract ( ) PDF ( )
    A 61-year-old female patient self-medicated with etoricoxib 30 mg once daily due to lower back pain. After continuous medication for 1 year and intermittent medication for 4 years, the patient experienced recurrent lower abdominal pain. Colonoscopy, small intestine ultrasound contrast, and full-body CT imaging, etc. did not show any significant organic lesions. Symptoms were temporarily alleviated with symptomatic treatments with antispasmodic and analgesic medications such as phloroglucinol and ibuprofen. Afterwards, the abdominal pain recurred and worsened as paroxysmal abdominal colic, which occurred more than 10 times daily, accompanied by nausea and vomiting. After receiving treatments such as antispasmodics and analgesics, the symptoms did not subside. Multiple membrane-like narrowing lesions in the ileum were discovered under double balloon enteroscopy and the patient was suspected of having small intestine diaphragm disease. Surgical resection of the affected intestinal tract was performed, and small intestine diaphragm disease was diagnosed by histopathological examination. One and 3 months after operation, no significant abnormalities were found in gastrointestinal imaging examination; after 6 months of follow-up, no  lower abdominal pain recurred in the patient.
  • Acarbose-induced intestinal obstruction
    Fang Gaofei, Zhao Guangchun, Ni Yingying
    2026, 28(2): 139-141. https://doi.org/10.3760/cma.j.cn114015-20250423-00221
    Abstract ( ) PDF ( )
    A 58-year-old male patient with type 2 diabetes for more than 10 years had not received standard treatment. Due to chest tightness and palpitations for 1 week, he received treatments with papaverine, Qiliqiangxin capsules (芪苈强心胶囊), nifedipine sustained-release tablets, aspirin enteric coated sustained-release tablets, nicotinamide, atorvastatin calcium, acarbose, and repaglinide. Before treatments, laboratory tests showed fasting blood glucose of 12.5 mmol/L, urinary glucose (+++) and urinary protein (+)；color Doppler ultrasound of the heart showed a left ventricular ejection fraction of 49%, mild left ventricular enlargement, wall thickening, and segmental wall motion reduction, as well as decreased left heart function. The patient was diagnosed as having acute exacerbation of chronic cardiac insufficiency, diabetes nephropathy stage Ⅲ, and type 2 diabetes mellitus. After 4 days of medication, the patient developed severe abdominal pain, particularly around the umbilicus, accompanied by decreased bowel sounds, and no bowel movements. Abdominal X-ray examination in an upright position and abdominal CT examination suggested intestinal obstruction. Laboratory tests showed a white blood cell count of 16.7×109/L and a neutrophil percentage of 87%. All of the above-mentioned medications were discontinued immediately. After 3 days of treatments including dietary restriction, gastrointestinal decompression, enema, fluid replacement, and anti-infection therapy, the patient′s abdominal pain was markedly improved. After 6 days of treatments, the liquid diet was restored, and after 9 days, the abdominal pain and bloating disappeared. Papaverine, Qiliqiangxin capsules, nifedipine sustained-release tablets, aspirin enteric coated sustained-release tablets, nicotinamide, atorvastatin, and repaglinide were given again. Acarbose was not given again, and intestinal obstruction did not recur. It was considered that the patient′s intestinal obstruction was related to acarbose.
  • Severe liver injury induced by Tongmai oral liquid (通脉口服液)
    Liang Yu, Meng Zhen, Xing Xiaomin, Quan Xianghua
    2026, 28(2): 142-144. https://doi.org/10.3760/cma.j.cn114015-20250304-00114
    Abstract ( ) PDF ( )
    A 57-year-old male patient self-administered Tongmai oral liquid 10 ml thrice daily for dizziness. After 22 days of medication, he developed nausea, poor appetite, and yellowish skin and sclera. Four days later, laboratory tests showed alanine aminotransferase (ALT) 1 544 U/L, aspartate aminotran- sferase (AST) 830 U/L, total bilirubin (TBil) 123.9 μmol/L, and direct bilirubin (DBil) 113.8 μmol/L. Serologic tests for hepatitis A, B, C, and E viruses and autoantibodies for autoimmune hepatitis were all negative. Upper abdominal CT scan revealed no significant abnormalities. Tongmai oral liquid was immediately discontinued, and hepatoprotective therapy with magnesium isoglycyrrhizinate injection was initiated. After 4 days of the treatment, the patient′s clinical symptoms and liver function were improved, and both contrast-enhanced upper abdominal CT and magnetic resonance cholangiopancreatography showed no significant abnormalities. Liver injury induced by Tongmai oral liquid was considered. After another 6 days of the treatment, the patient′s yellowish skin and sclera markedly subsided, and the liver function was further improved (ALT 433 U/L, AST 145 U/L, TBil 34.7 μmol/L, DBil 25.2 μmol/L). The above liver protection treatment was switched to oral diammonium glycyrrhizinate enteric-coated capsules. At the 45 day follow-up, the patient was asymptomatic with normalized liver function (ALT 32 U/L, AST 27 U/L, TBil 19.2 μmol/L, DBil 3.4 μmol/L).
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