甘草及甘草酸制剂引起的假性醛固酮增多症及防治  

Licorice and glycyrrhizinic acid preparation-induced pseudohyperaldosteronism:prevention and treatment

作　　者：刘然[1] 

机构地区：[1]北京积水潭医院药剂科,北京100035

出　　处：《药物不良反应杂志》2009年第6期416-419,共4页Adverse Drug Reactions Journal

摘　　要：甘草是常用中药,主要含有甘草甜素(甘草酸)、甘草次酸及黄酮类化合物。大剂量或长期使用甘草或甘草酸,可引起假性醛固酮增多症,临床表现为血压升高、心悸、气短、心律失常、嗜睡、全身乏力、四肢麻痹、低血钾、下肢和全身水肿等。老年人、妇女、心血管疾病和肾损害者易发生此症。甘草及甘草酸制剂引起的假性醛固酮增多症和抑制11β-氢化类固醇脱氢酶及增加盐皮质激素受体活性有关。防治措施包括:甘草及甘草酸制剂不宜大剂量或长期使用;老年人、心血管疾病和肾脏疾病、高血压、糖尿病患者应慎用;尽量避免与强心苷、利尿剂等合用;用药期间应定期检查血清钾值和测定血压;一旦发生假性醛固酮增多症,应立即停药;重症患者适当补充钾盐,口服氨苯蝶啶,给予低钠饮食等。Licorice is a commonly used traditional Chinese medicine which mainly contains glycyrrhizin（glycyrrhizinic acid）,glycyrrhetinic acid,and flavonoid.Large dosage or long-term use of licorice or glycyrrhizinic acid may cause pesudo-hyperaldosteronism.Clinical presentations are increased blood pressure,palpitation,shortness of breath,arrhythmia,somnolence,generalised asthenia,tetraplegia,hypokalemia,lower limb and systemic edema,etc.The subjects prone to developing pseudohyperaldoteronism include the elderly,women,and those with cardiovascular disease or renal impairment.The mechanism of pseudohyperaldoteronism from licorice or glycyrrhizinic acid is associated with inhibition of 11 beta-hydroxysteroid-dehydrogenase and increased activation of mineralocorticoid receptors.The measures of prevention and treatment are as follows： large dosage and long-term use of licorice or glycyrrhizinic acid should be avoid;the drug should be used very carefully in the elderly,the patients with cardiovascular disease,renal disease,hypertension,and diabetes mellitus;licorice or glycyrrhizinic acid in combination with cardiac glycoside or diuretics should be avoided;serum potassium level should be measured and blood pressure should be monitored regularly during drug therapy;once pseudohyperaldosteronism occurs,the drug should be stopped;patients with severe symptoms should be administered an appropriate potassium supplement,oral triamterence,and a low sodium diet.

关 键 词：甘草 甘草酸 假性醛固酮增多症 防治 

分 类 号：R595.3[医药卫生—内科学]