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ObjectiveTo investigate the association between urinary thallium （TL） and nonalcoholic fatty liver disease （NAFLD）. MethodsRelated data were collected from the registered participants aged ≥18 years in National Health and Nutrition Examination Survey from 2017 to 2020， with th exclusion of the individuals with a lack of liver transient elastography data and urinary TL indicators and those with hepatitis B， hepatitis C or significant alcohol consumption. A total of individuals were divided into NAFLD group and non-NAFLD group. Urinary TL level was quantitatively measured using high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry and online solid-phase extraction combined with isotope dilution. The two groups were compared in terms of age， sex， race， marital status， education， family income poverty impact ratio （FMPIR）， body mass index （BMI）， smoking， alcohol consumption， diabetes mellitus （DM）， hypertension （HTN）， hyperlipidemia （HL）， and urinary TL level. The independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Descriptive analysis， multivariable Logistic regression， restricted cubic spline regression analysis， subgroup analysis， and interaction analysis were conducted to investigate the risk association between urinary TL and NAFLD. ResultsA total of 2 511 individuals were included， with 1 612 （64.20%） in the NAFLD group and 899 （35.80%） in the non-NAFLD group， and the NAFLD group had a significantly higher urinary TL level than the non-NAFLD group ［0.18 （0.11 — 0.26）μg/L vs 0.16 （0.09 — 0.25）μg/L， Z=-2.76， P=0.01］. After adjustment for the covariates of age， sex， race， education， marital status， FMPIR， BMI， smoking， alcohol consumption， DM， HTN， and HL， the urinary TL Q4 group had a significant increase in the risk of NAFLD （odds ratio ［OR］=1.90， 95% confidence interval ［CI］： 1.48 — 2.44， P<0.01）. There was a positive dose-response relationship （P<0.01） and a non-linear relationship （P<0.01） between urinary TL and the risk of NAFLD. A significant interaction was observed between urinary TL and smoking/BMI （P<0.05）. For individuals taking ≥100 cigarettes in their lifetime， the risk of NAFLD was increased by 50% for every quartile increase in urinary TL （OR=1.50， 95%CI： 1.24 — 1.80）， and for individuals taking<100 cigarettes in their lifetime， the risk of NAFLD was increased by 20% for every quartile increase in urinary TL （OR=1.20， 95%CI： 1.03 — 1.40）； for individuals with a BMI of ≥30 kg/m2， the risk of NAFLD was increased by 30% for every quartile increase in urinary TL （OR=1.30， 95%CI： 1.05 — 1.70）， with a statistical significance （P<0.05）. ConclusionUrinary TL level is significantly associated with the risk of NAFLD.
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Polygonum multiflorum （PM）， a commonly used Chinese herbal medicine in clinical practice， has been associated with frequent reports of liver injury in recent years， and the medication safety of PM has attracted more and more attention in China and globally. This article reviews the recent research advances in the signaling pathways and mechanisms of PM in causing drug-induced liver injury （DILI） and aims to provide new ideas for the proper and rational use of PM in clinical practice. The results show that PM is involved in the regulation of various signaling pathways， and it leads to the death of hepatocytes by destroying mitochondrial function， exacerbating bile acid accumulation， and inducing immune response， oxidative stress， and endoplasmic reticulum stress， thereby inducing the development and progression of DILI through multiple targets， pathways， and levels.