摘要
目的分析何首乌肝毒性的客观真实性与何首乌及其制剂导致药物性肝损伤(drug-induced liver injury,DILI)的临床特征。方法回顾性分析2009年1月—2014年1月解放军第三〇二医院收治的158例发病前有何首乌及其制剂应用史DILI患者的临床特征及治疗预后等临床资料。结果 158例发病前有何首乌及其制剂应用史的DILI患者中,92例(58.2%)与西药或不含何首乌中药制剂联合应用,66例(41.8%)仅应用何首乌及其制剂。在66例仅应用何首乌及其制剂导致DILI患者中,51例(77.3%)为何首乌复方,15例(22.7%)为单味何首乌;4例(6.1%)为生首乌及其制剂,62例(93.9%)为制首乌及其制剂;61例(92.4%)临床分型为肝细胞损伤型,1例(1.5%)为胆汁淤积型,4例为混合型(6.1%)。32例(48.5%)行肝脏穿刺组织病理学检查,可见肝细胞变性坏死、纤维组织增生、含吞噬色素颗粒Kupffer细胞和大量嗜酸性粒细胞浸润等病理表现;4例患者进展为肝功能衰竭,4例肝硬化,1例死亡。结论何首乌及其制剂可导致DILI,但何首乌肝毒性的临床诊断仍需谨慎。
Objective To analyze hepatotoxicity of Polygonum multiflorum and clinical characteristics of drug-induced liver injury（ DILI） caused by Polygonum multiflorum and its preparations. Methods A retrospective study was performed in 158 patients treated at 302 Military Hospital between January 2009 and January 2014. All of them had used Polygonum multiflorum and its preparations before the onset of DILI,and their clinical characteristics and prognoses were analyzed. Results Of the 158 DILI patients who used Polygonum multiflorum or its preparations,92（ 58. 2%） combined with Western medicine or Chinese herbal preparations without Polygonum multiflorum; 66 patients（ 41. 8%） used Polygonum multiflorum and its preparations alone. In 66 DILI patients induced by Polygonum multiflorum or its preparations alone,51cases（ 77. 3%） were induced by Polygonum multiflorum compounds and 22. 7% by single Polygonum multiflorum; 4 cases（ 6. 1%） were caused by crudeP olygonum multiflorum and 62（ 93. 9%） by processed Polygonum multiflorum and its preparations. Clinical injury patterns were hepatocellular 92. 4%（ 61 cases）,cholestatic 1. 5%（ 1 case）,and mixed 6. 1%（ 4 cases）. Pathological examination was performed by liver biopsy in 32 cases（ 48. 15%）,manifested as hepatocellular degeneration and necrosis,fibroplasia,Kupffer cells with pigment granule,and a large number of eosinophil infiltration,were observed. Four patients were developed into liver failure,4 into cirrhosis,and 1 died. Conclusion Polygonum multiflorum and its preparations could induce DILI,but clinical diagnosis ofP olygonum multiflorum induced hepatotoxicity should be cautious.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2015年第12期1442-1447,共6页
Chinese Journal of Integrated Traditional and Western Medicine
基金
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
何首乌
肝毒性
临床特征
病理表现
Polygonum multiflorum
hapatotoxicity
clinical characteristics
pathological manifestation
作者简介
通讯作者：肖小河，Tel：010-66933322，E-mail：pharmacy302@126．com
