Evidence chain-based causality identification in herb-induced liver injury： exemplification of a well-known liver-restorative herb Polygonum multiflorum  

作　　者：Jiabo Wang Zhijie Ma Ming Niu Yun Zhu Qingsheng Liang Yanling Zhao Jingyuan Song Zhaofang Bai Yaming Zhang Ping Zhang Na Li Yakun Meng Qi Li Lushan Qin Guangju Teng Junling Cao Baosen Li Shilin Chen Yonggang Li Zhengsheng Zou Honghao Zhou Xiaohe Xiao 

机构地区：[1]China Military Institute of Chinese Medicine, 302 Military Hospital Beijing 100039, China [2]Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China [3]Diagnosis and Treatment Center for Non-infectious Diseases, 302 Military Hospital, Beijing 100039, China [4]Institate of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China [5]Integrative Medical Center, 302 Military Hospital, Beijing 100039, China [6]Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China [7]Diagnosis and Treatment Center of Western and Chinese Medicine for Liver Diseases, 302 Military Hospital, Beijing 100039, China [8]Institute of Clinical Pharmacology, Central South University, Changsha 410008, China

出　　处：《Frontiers of Medicine》2015年第4期457-467,共11页医学前沿（英文版）

基　　金：Acknowledgements This work was supported by the National Key Technology R＆D Program （No. 2015ZX09501-004-001-008）, the National TCM Industry Science and Technology Program （No. 201507004-04）, the National Natural Science Foundation of China （Nos. 81373984, 81503350, and 81403126）, and the Beijing Natural Science Foundation （No. 7152142）. The authors wish to acknowledge Jiyan Chen for providing photographs of fraudulent Heshouwu, Yonghe Zhang for determining the pesticides, and Dongping Xu for his suggestion regarding the scale table of ECCIA.

摘　　要：Herbal medicines have recently been recognized as the second most common cause of drug-induced liver injury （DILI） in the United States. However, reliable methods to identify the DILl causality of some herbs, such as Heshouwu （dried root ofPolygonum multiflorum）, remain lacking. In this study, a total of 12 307 inpatients with liver dysfunction and 147 literature-reported cases of Heshouwu DILI were screened. A general algorithm indicated that only 22.5% （9/40） and 30.6% （45/147） of all hospitalization and literature case reports, respectively, demonstrate the high probability of DILI causality of Heshouwu. By contrast, 95% （19/20） of all cases prospectively investigated by pharmacognosy, phytochemistry, and metabolomic tests exhibited highly probable causality, including a patient who was previously incorrectly attributed and a case that was excluded from Heshouwu causality by pharmacognostic evidence. Toxin （heavy metals, pesticides, and mycotoxins） contamination was also excluded from Heshouwu DILI causality. The objectivity of these screening methods for Heshouwu DILI diagnosis addresses safety concerns regarding stilbene-containing herbal medicines and dietary supplements.Herbal medicines have recently been recognized as the second most common cause of drug-induced liver injury （DILI） in the United States. However, reliable methods to identify the DILl causality of some herbs, such as Heshouwu （dried root ofPolygonum multiflorum）, remain lacking. In this study, a total of 12 307 inpatients with liver dysfunction and 147 literature-reported cases of Heshouwu DILI were screened. A general algorithm indicated that only 22.5% （9/40） and 30.6% （45/147） of all hospitalization and literature case reports, respectively, demonstrate the high probability of DILI causality of Heshouwu. By contrast, 95% （19/20） of all cases prospectively investigated by pharmacognosy, phytochemistry, and metabolomic tests exhibited highly probable causality, including a patient who was previously incorrectly attributed and a case that was excluded from Heshouwu causality by pharmacognostic evidence. Toxin （heavy metals, pesticides, and mycotoxins） contamination was also excluded from Heshouwu DILI causality. The objectivity of these screening methods for Heshouwu DILI diagnosis addresses safety concerns regarding stilbene-containing herbal medicines and dietary supplements.

关 键 词：Polygonum multiflorum Chinese herbal medicine drug-induced liver injury PHARMACOGNOSY metabolomics STILBENE 

分 类 号：S567.239[农业科学—中草药栽培] TP391.9[农业科学—作物学]