药食同源蒲公英致肝损伤临床病例分析  

Clinical case analysis of liver injury induced by dandelion,a food‑medicine homologous traditional Chinese medicine

作　　者：刘金春[1] 佟瑞 盛香玲 房其军[3] 吴卫华[4] Liu Jinchun;Tong Rui;Sheng Xiangling;Fang Qijun;Wu Weihua(Department of Pharmacy,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing Medical Center for Clinical Pharmacy,Nanjing 210008,China;School of Basic Medicine and Clinical Pharmacy,China Pharmaceutical University Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Traditional Chinese Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Infectious Disease,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院药学部,南京临床药学中心,南京210008 [2]中国药科大学南京鼓楼医院基础医学与临床药学学院,南京210008 [3]南京大学医学院附属鼓楼医院中医科,南京210008 [4]南京大学医学院附属鼓楼医院感染性疾病科,南京210008

出　　处：《药物不良反应杂志》2024年第11期665-671,共7页Adverse Drug Reactions Journal

基　　金：蚌埠医学院感染与免疫安徽省重点实验室研究项目(AHIAI2023R02);南京大学中国医院改革发展研究院课题项目和南京鼓楼医院医学发展医疗救助基金会资助项目(NDYGN2023006)。

摘　　要：目的分析药食同源的蒲公英致肝损伤的发生情况和临床特征。方法2017年1月1日至2023年12月31日南京大学医学院附属鼓楼医院感染性疾病科收治的因服用蒲公英致肝损伤的患者纳入本研究。收集患者的电子病历,记录一般资料、服用蒲公英情况、联合用药情况、临床表现、肝脏生化检测结果;评价蒲公英与肝损伤的因果关系,回顾性分析患者的临床表现、肝损伤分型、严重程度、治疗及预后。结果纳入本研究的患者共13例,女性8例,男性5例;年龄29~78岁;9例自行服用蒲公英,4例遵医嘱服用蒲公英;服用方式为蒲公英根茶饮、全草茶饮及打粉冲服。多数患者的肝损伤发生在服用蒲公英后90 d内。主要临床表现为皮肤巩膜黄染,尿液颜色加深,腹胀、腹痛、食欲不振等。实验室检查结果示13例患者均出现血清转氨酶和胆红素升高,12例碱性磷酸酶升高,5例血氨升高。因果关系评价结果8例为很可能,5例为极可能。临床分型示肝细胞型11例,混合型2例;严重程度主要为2级(8例),3级(2例)和4级(2例)患者发生了肝衰竭。予对症治疗后,11例患者肝功能恢复正常或好转;2例病情进展,其中1例行肝移植术后存活,1例死亡。结论蒲公英可致肝损伤,多发生于服用后90 d内,严重程度多为中度,停用蒲公英并予对症治疗后多数患者预后良好;但有发生肝衰竭和死亡的风险。Objective To analyze the occurrence and clinical features of liver injury induced by dandelion,a food‑medicine homologous traditional Chinese medicine.Methods The patients with liver injury caused by taking dandelion,who were admitted to the Department of Infectious Diseases,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 1,2017 to December 31,2023,were enrolled in this study.The electronic medical records of the patients were retrieved,and the patients′general information,using of dandelion,combined medication,clinical manifestations,and liver biochemical test results were recorded.The causal relationship between dandelion and the liver injury were evaluated,and the clinical manifestations,classification,severity,treatment and prognosis of liver injury were analyzed.Results A total of 13 patients were enrolled in the study,including 8females and 5 males.The age ranged from 29 to 78 years.Nine patients took dandelion by themselves,and 4 according to the doctor′s advice.The administration methods included dandelion root tea drink,whole herb tea drink,and powder drink mixed in water.Most patients′liver injury occurred within 90 days after taking dandelion.The main clinical manifestations were yellowish staining of skin and sclera,dark urine,abdominal distension,abdominal pain,loss of appetite,etc.The laboratory tests showed that serum aminotransferase and bilirubin increased in 13 patients,alkaline phosphatase increased in 12 patients,and plasma ammonia increased in 5 patients.The causality evaluation results showed"probable related"in 8 cases and"highly probable related"in 5 cases.The clinical classification showed that 11 patients were of hepatocellular type and 2 of mixed type.The severity was mainly grade 2(8 of 13 patients).Two patients with grade 3 and 2 patients with grade 4 developed liver failure.After symptomatic treatments,11 patients′liver function returned to normal or were improved;2 patients′condition progressed,of which 1 patient surv

关 键 词：中草药 蒲公英属 化学和药物性肝损伤 药食同源 

分 类 号：R285.6[医药卫生—中药学]