165例中草药导致药物性肝损害临床特征及病理分析  

Clinical Features and Pathological Analysis of 186 Patients with Liver Injury Induced by Chinese Herbal Medicine

作　　者：滕光菊[1] 梁庆升[1] 孙颖[1] 常彬霞[1] 张伟[1] 赵军[1] 田辉[1] 尚丽丹[1] 邹正升[1] 李保森[1] 

机构地区：[1]解放军第302医院非感染肝病诊疗中心,北京100039

出　　处：《中华中医药学刊》2014年第4期913-916,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：解放军第302医院立项课题(YNKT2013012)

摘　　要：目的:探讨中草药引起药物性肝损害(drug induced liver injury,DILI)的临床及病理特征,以引起临床医师对中草药诱导肝损害的重视和提高诊断水平。方法:回顾性总结我院近3年收治的165例中草药引起的DILI患者临床资料,分析其中药成分、临床表现、肝损害、肝组织病理及治疗转归等相关指标。结果:中药引起的DILI以女性(99例,60%)为主。这些中草药主要是治疗皮肤病(24.2%)、胃病(10.9%)、感染(7.3%)和骨关节疾病(6.1%)等。引起药物性肝损害的单味中药主要有雷公藤、何首乌、土三七等。中成药主要有克银丸、银屑灵、壮骨伸筋胶囊等。165例患者中药物性肝衰竭35例(占21.2%),急性药性肝损害87例(占52.7%),慢性药性肝损害41例(占24.8%),药物性肝硬化2例(占1.2%)。根据国际医学科学组织理事会(CIOMS)分型的标准,肝细胞损害型92例(占55.8%),胆汁淤积型40例(占24.2%),混合型33例(占20%)。165例DILI患者中治愈55例(33.9%),好转82例(49.7%),无效22例(13.3%),死亡5例(3%)。结论:中草药引起DILI的临床和病理特征与西医组相比,无明显特异性。在使用中草药时,应该重视中草药的肝毒性,加强管理,定期、动态监测患者的肝功能。Objective. To investigate the clinical and pathological features of patients with liver injury induced by Chi- nese herbal medicine so as to improve the ability of diagnosis and treatment of drug - induced liver injury （DILI）. Methods： 165 patients with liver injury induced by Chinese herbal medicine admitted to our hospital from February 2009 to February 2012 were reviewed according to their drug history ,clinical features, lab tests ,pathological characteristics and related prognosis factors retrospectively. Results： Among 165 patients ,99 cases （60%） were female. The underlying dis-eases in 165 patients were dermatosis （ 24.2% ）, gastrosis （ 10.9 % ）, infection （ 7.3 % ）, bone and joint - related diseases （6.1% ）. Among the patients with DILI, 35 cases （21.2%） were drug - induced liver failure, 87 cases （52.7%） acute DILl cases ,41 case（ 24.8% ）chronic DILl ,2 cases（ 1.2% ）drug -induced liver cirrhosis, respectively. According the cri- teria of Council for International Organizations of Medical Sciences,92 cases （ 55.8% ） were hepatocellular type,40 cases （24.2%） cholestasis type,and 33 cases （20%） mixed type. The overall cure rate was 33.9% ;the improvement rate was 49.7% ;the worsening rate was 13.3% and the mortality was 3.0% , respectively. Conclusion： Patients with DILI in- duced by Chinese herbal had no specific clinical and pathological manifestations. Therefore ,we should dynamically test the hepatic function of patients who are treated with Chinese herbal medicine and should pay attention to the hepatotoxicity of Chinese herbal medicine.

关 键 词：药物性肝损害 中草药 临床特征 

分 类 号：R595.3[医药卫生—内科学]