何首乌及其相关制剂致药物性肝损伤12例临床分析  

Clinical analysis of 12 cases of drug-induced liver injury associated with polygonum multiflorum and its preparations

作　　者：王熊 孙克伟 田涛 曾维涛 袁维 WANG Xiong;SUN Ke-wei;TIAN Tao;ZENG Wei-tao;YUAN Wei(Department of Hepatology,the First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 41007,China;Hunan University of Traditional Chinese Medicine,Changsha 410208,China)

机构地区：[1]湖南中医药大学第一中医临床学院,长沙410007 [2]湖南中医药大学

出　　处：《肝脏》2024年第12期1538-1540,共3页Chinese Hepatology

基　　金：长沙市杰出创新青年培养项目计划(kq2209020);湖南中医药大学优秀青年项目(2022XJB006)。

摘　　要：目的分析何首乌及其相关制剂导致的药物性肝损伤(DILI)的特点。方法回顾性分析2017年1月至2024年3月在湖南中医药大学第一附属医院肝病科因服用何首乌及其相关制剂而被诊断为DILI的12例住院患者的临床资料。结果12例患者中,女性9例,男性3例,年龄(47.7±16.1)岁。从服药到发病时间为1 d至6个月。12例患者临床分型均为肝细胞损伤型,乏力、纳差、身目尿黄为主要临床表现。严重程度:1级8例,3级3例,4级1例。3级以上患者均为服用中药方剂所致。服用中成药的患者肝损伤程度主要为轻度。停用何首乌及其制剂,以及给予积极护肝降酶等对症支持治疗后好转出院。结论何首乌及其相关制剂所致DILI多为肝细胞损伤型,服用何首乌及其相关制剂时,应严密监测患者的肝功能,及时发现并积极治疗,多数DILI患者预后良好。Objective To analyze the characteristics of drug-induced liver injury(DILI)associated with Polygonum multiflorum(PM)and its preparations,in order to raise clinical awareness and provide a basis for rational diagnosis and treatment.Methods A retrospective analysis was performed on the clinical data of 12 hospitalized patients diagnosed with DILI,who had a history of using taking PM and its preparations,from January 2017 to March 2024 at the First Affiliated Hospital of Hunan University of Chinese Medicine,Department of Hepatology.Results Among the 12 patients,9 were female and 3 were male,with a mean age of 47.7±16.1 years.The time from drug intake to onset ranged from 1 day to 6 months,with a mean of 70.6±80.1 days.All 12 patients were clinically classified as having hepatocellular injury,with fatigue,poor appetite,and jaundice as the main clinical manifestations.The severity of the injury was classified as follows:8 cases(66.7%)were grade 1,3 cases(25%)were grade 3,and 1 case(8.3%)was grade 4.All patients with grade 3 or above had used traditional Chinese medicine formulations.Patients using proprietary Chinese medicines primarily experienced mild liver injury.All patients improved and were discharged after discontinuing PM and its formulations,along with receiving active liver protection and enzyme-reduction symptomatic supportive treatment.Conclusion DILI caused by PM and its preparations is primarily of the hepatocellular injury type.Clinicians should prescribe these drugs scientifically,according to standardly,and with rational judgement.When using PM and its preparations,close monitoring of liver function is essential,DILI should be detected promptly and managed actively,and the prognosis for most patients with DILI is favorable.

关 键 词：何首乌 药物性肝损伤 临床特征 

分 类 号：R28[医药卫生—中药学]