何首乌相关肝损伤的临床及病理特征研究  

Study on clinical and pathological characteristics of Polygonum multiflorum-associated liver injury

作　　者：赵红[1] 刘丽改[1] 孙磊[2] 谢雯[1] Zhao Hong;Liu Ligai;Sun Lei;Xie Wen(Liver Disease Center,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Pathology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院肝病中心,北京100015 [2]首都医科大学附属北京地坛医院病理科,北京100015

出　　处：《药物不良反应杂志》2021年第8期416-423,共8页Adverse Drug Reactions Journal

基　　金：北京市医院管理局北京市属医院科研培育计划项目(PX2016027);北京市医院管理局2018年度消化内科学科协同发展中心重点项目(XXT27)。

摘　　要：目的探讨何首乌相关肝损伤的临床和病理特征。方法收集首都医科大学附属北京地坛医院2009年1月至2018年12月经组织病理学检查诊断为何首乌相关肝损伤住院患者的病历资料进行回顾性分析。根据所用何首乌炮制方法的不同,将患者分为生何首乌组和制何首乌组,比较2组患者的临床和病理特征。结果纳入分析的患者为22例,生何首乌组8例,男性、女性各4例,中位年龄32(25,37)岁;制何首乌组14例,男性2例,女性12例,中位年龄51(38,58)岁;临床分型21例为肝细胞损伤型,1例(制何首乌组)为混合型;均有不同程度的急性肝炎相关症状。生何首乌组丙氨酸转氨酶、天冬氨酸转氨酶和总胆红素中位峰值水平均明显高于制何首乌组[1832(1134,2301)U/L比900(456,1102)U/L,P=0.001;1135(475,1408)U/L比466(240,662)U/L,P=0.017;212.1(102.5,363.4)μmol/L比59.7(17.7,117.3)μmol/L,P=0.012]。2组患者肝脏病理均以急性小叶性肝炎为主要表现。发生肝损伤后22例患者均停用何首乌制剂并给予对症处理,住院9~37 d后均病情好转出院。出院后1例失访,余21例肝功能均恢复正常,肝功能复常的中位时间为3(2,6)个月,其中3例肝功能异常持续时间超过6个月。结论何首乌相关肝损伤临床分型以肝细胞损伤型多见,肝脏病理特征为急性小叶性肝炎。生何首乌所致肝损伤的程度重于制何首乌。停用何首乌并给予对症处理,多数患者预后良好。Objective To explore the clinical and pathological characteristics of Polygonum multiflorum-associated liver injury.Methods Medical record data of inpatients with Polygonum multiflorum-associated liver injury diagnosed by histopathological examination between January 2009 and December 2018 in Beijing Ditan Hospital,Capital Medical University were collected and analyzed retrospectively.According to the different processing methods of Polygonum multiflorum,the patients were divided into raw Polygonum multiflorum group and prepared Polygonum multiflorum group.The clinical and pathological characteristics in patients in the 2 groups were compared.Results A total of 22 patients entered the study.Of them,8 patients were in the raw Polygonum multiflorum group,including 4 males and 4 females with a median age of 32(25,37)years;14 patients were in the prepared Polygonum multiflorum group,including 2 males and 12 females with a median age of 51(38,58)years.Twenty one patients were clinically identified as hepatocellular injury type and one patient(raw Polygonum multiflorum group)was identified as mixed type,which all had varying degrees of acute hepatitis related symptoms.The median peak levels of alanine aminotransferase,aspartate aminotransferase,and total bilirubin in the raw Polygonum multiflorum group were significantly higher than those in the prepared Polygonum multiflorum group[1832(1134,2301)U/L vs.900(456,1102)U/L,P=0.001;1135(475,1408)U/L vs.466(240,662)U/L,P=0.017;212.1(102.5,363.4)μmol/L vs.59.7(17.7,117.3)μmol/L,P=0.012].The main pathological manifestation of liver injury in patients in the 2 groups was acute lobular hepatitis.After the occurrence of liver injury,all 22 patients discontinued Polygonum multiflorum preparation and were given symptomatic treatment,and all were improved and discharged after 9-37 d of hospitalization.After discharge,one patient lost the follow-up and the other 21 patients′liver function recovered,with a median time to recovery of 3(2,6)months.Three patients′abnormal liver fu

关 键 词：化学和药物性肝损伤 中草药 何首乌 

分 类 号：R285.6[医药卫生—中药学]