冠心苏合丸相关性肾脏损害的临床特征(附27例分析)  

Clinical characteristics of tubulointerstitial nephropathy caused by Guanxinsuhe pill (冠心苏合丸):a clinical analysis of 27 cases

作　　者：宋岩[1] 姚凤华[1] 张壹言[1] 姚咏明[1] 李冀军[1] 陈凤琨[1] 李学义[1] 

机构地区：[1]解放军总医院第一附属医院肾内科,北京100037

出　　处：《中国中西医结合急救杂志》2007年第4期205-208,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：北京市科技计划重大项目(H020920020530)

摘　　要：目的:探讨冠心苏合丸(含青木香)相关的肾脏损害的临床特点。方法:回顾27例服用冠心苏合丸出现肾脏损害患者的临床资料,分析冠心苏合丸引起肾脏损害的临床特点,探讨服药至发现肾功能损害时间、服药时间、贫血和肾功能损害的关系。结果:27例患者均因疑诊冠心病服用冠心苏合丸。临床上均表现为慢性小管间质性肾病,伴有肾小管酸中毒、肾性糖尿、低渗尿,贫血程度较肾功能减退程度重;有26例出现肾萎缩;发现时19例(占70.4%)患者已进入慢性肾病5期,8例(占29.6%)进入慢性肾病3～4期。就诊主诉多为乏力、纳差、恶心和呕吐等非特异性症状和夜尿增多,均伴有不同程度的慢性肾功能减退。24 h尿蛋白定量为120～900 m g,平均(490±250)m g;镜检少有红、白细胞。16例患者按说明书规定的药典剂量(每次1粒,每日2～3次)长期间断服用冠心苏和丸,10例超过药典规定剂量服用(每次2粒,每日2～3次);27例中有26例为间断反复服用,有1例持续服用冠心苏合丸直至发现肾功能不全。服药时间1～120个月,平均(37.38±31.58)个月;总用药量约50～43 800粒,平均(4 576.00±8 830.54)粒,有3例用药总量不详;开始服药至发现肾脏损害的时间为30～216个月,平均(95.41±56.74)个月。相关分析表明,肾功能减退程度与贫血程度、服药时间明显相关。结论:服用冠心苏合丸可引起肾脏损害,且药典规定剂量的冠心苏合丸即可导致肾脏损害。冠心苏合丸所致肾脏损害起病隐袭,多有冠心病史,发现时绝大多数患者已进入慢性肾病5期。临床上均表现为慢性小管间质性肾病,均有肾小管功能异常及贫血,贫血程度与肾功能减退程度不平行,24 h尿蛋白量均低于1 000 m g。建议临床上应避免服用冠心苏合丸,调整冠心苏合丸组方,停用青木香。Objective： To investigate the clinical characteristics of renal injury caused by Guanxinsuhe pill [冠心苏合丸, including slander dutchanspipe root （青木香）]. Methods ： The clinical data of 27 patients with renal injury caused by Guanxinsuhe pill were studied. The clinical characteristics of the renal damage caused by Guanxinsuhe pill and the relationships between duration of illness, duration of taking Guanxinsuhe pill, anemia, renal atrophy and the progression of renal injury respectively were also analyzed. Results： Twenty-seven patients all taken Guanxinsuhe pill for suspicious coronary heart disease （CHD） and were diagnosed as chronic tubulointerstitial nephropathy accompanied with renal tubular acidosis, renal glucosuria and hyposthenuria after admission. Anemia was of more severity than renal dysfunction. Atrophic kidney occurred in 26 patients. The main complains were non-specific symptoms including fatigue, anorexia, nausea, vomiting, etc. and accompanied with different degrees of chronic renal dysfunction. Twenty - four hours urinary protein excretions were 120- 900 mg [（490±250） mg]. There were few red and white cells in uroscopy. Sixteen patients discontinuously took the Guanxinsuhe pill （one capsule, 2 - 3 times a day） according to the pharmacopoeia for a long period. Ten patients took a dosage （two capsules, 2 - 3 times a day） higher than that limited by the pharmacopoeia. Twenty -six patients took Guanxinsuhe pill discontinuously. One patient continuously took Guanxinsuhe pill until got renal dysfunction. The duration of taking Guanxinsuhe pill was 1 - 120 months （37.38±31.58）, and the amount of 50 - 43 800 pills （4 576.00± 8 830. 54） were used, but the amount of pills of 3 cases was uncertain. The renal injury occurred within 30 - 216 months （95.41 ± 56. 74） after initiation of the drug taken. The renal injury obviously correlated with the anemia and the duration of taking Guanxinsuhe pill. Conclusion： Taking Guanxinsuhe pill can cause renal injur

关 键 词：冠心苏合丸 青木香 冠心病 肾脏损害 

分 类 号：R692[医药卫生—泌尿科学]