摘要
目的观察中药导致肝损伤（herb-induced liver injury,HILI）临床特征。方法回顾性分析2009年1月—2014年1月解放军第302医院595例HILI住院患者一般情况、用药史、临床表现、生化指标、预后、因果关系评分（Roussed Uclaf Causality Assessment Method,RUCAM）。结果423例（71.1%）HILI患者为女性,多发年龄段为41~50岁,中药开始应用至发生肝损伤的中位时间为30（15,75）天,511例（85.9%）临床分型为肝细胞损伤型;导致HILI中药主要用于治疗皮肤病102例（17.1%）、骨关节疾病57例（9.6%）、消化道系统疾病49例（8.2%）等,涉及207种中成药,中药组方中常见何首乌、补骨脂、延胡索;RUCAM评分中,451例（75.8%）HILI与中药关联性为＂很可能有关＂;47例（7.9%）出现肝衰竭,45例（7.6%）发生肝硬化,80例（13.4%）形成慢性,27例（4.5%）死亡,2例（0.3%）行肝移植。结论中药可导致肝损伤甚至死亡,应重视中药肝毒性,完善HILI监测体系。
Objective To observe clinical characteristics of herb-induced liver injury（HILI）.MethodsGeneral conditions,medical history,clinical manifestations,biochemical indices,prognosis,and Roussed Uclaf Causality Assessment Method（RUCAM）scores were retrospectively analyzed in595 inpatients at 302 Military Hospital between January 2009 and January 2014.Results There were 423 cases（accounting for 71.1%）were females with multiple onset age ranging 41 to 50 years old.The median time from starting Chinese herbs to the occurrence of liver injury（LI）was 30 days（15-75 days）,and511 cases（85.9%）were classified as hepatocellular injury.Chinese herbs inducing HILI were mainly used for skin disease（102 cases,17.1%）,osteoarticular disease（57 cases,9.6%）,and gastrointestinal disease（49 cases,8.2%）,covering 207 kinds of Chinese patent medicines.Polygonum multiflorum,Psoralea corylifolia,and Corydalis ambigua were often seen in Chinese prescriptions.In RUCAM scoring,451 HILI patients（accounting for 74.1%）were very possibly associated with Chinese herbs.Liver failure occurred in 47 HILI patients（accounting for 7.9%）,cirrhosis in 45 patients（accounting for 7.6%）,chronic HILI in 80 patients（accounting for13.4%）,27（4.5%）died,and only 2（0.3%）underwent liver transplantation.Conclusions Chinese herbs could cause LI or even death.Attention should be paid to herbal hepatotoxicity and improving monitoring system of HILI.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2016年第1期44-48,共5页
Chinese Journal of Integrated Traditional and Western Medicine
基金
北京市自然科学基金资助项目(No.7152142)
国家“十二五”科技重大专项(No.2012ZX10005010-002-002)
国家“重大新药创制”科技重大专项课题(No.2015ZX09501-004-001-008)
关键词
中药
肝损伤
临床特征
因果关系评估
预后
Chinese herbal medicine
liver injury
clinical characteristics
Roussed Uclaf Causality Assessment Method
prognosis
