口服何首乌致肝损害40例临床分析

Liver injury by peroral ploygonum multiflorum:an analysis of 40 cases

目的分析何首乌致药物性肝损害的临床特点。方法对我科2004年5月-2008年5月期间共收治的40例口服何首乌致药物性肝损害的病例的临床资料进行回顾性分析。结果40例病例中男性16例,女性24例,平均发病年龄45.2岁;服药原因主要为治疗脱发、白发;服药后发病时间最早的1.3周,最晚的24周,平均9.4周;服药剂量大部分为常规剂量,仅2例为大剂量。临床分型：肝细胞损伤型为22例（占55%）,胆汁淤积型为8例（占20%）,混合型为10例（占25%）。临床表现主要为乏力、食欲减退、尿黄,其中有2例后期出现腹水,1例出现上消化道出血。肝功能损害以总胆红素、丙氨酸转氨酶明显升高为主。临床治愈38例,死亡2例。结论口服何首乌可引起肝功能损害,甚至诱发急性肝衰竭,对于有肝脏基础疾病及老年人应慎重使用。

Objective To study the clinical features of drug-induced liver injury by peroral ploygonum muhiflorum. Methods 0 case of drug-induced liver injurycaused by peroral ploygonum multiflorum were retrospectively analyzed, which came from the in-patients between May 2004 and May 2008. Results The average age of the patients was 45.2 years, and there were 16 men and 24 women. The causes of peroral ploygonum muhiflorum were almost to cure alopeciaor or canities. The earliest onset time of liver injury was 1.3 weeks after peroral ploygonum multiflorum, the latest was 24 weeks and the average was 9.4 weeks. In most cases the dosage of peroral ploygonum multiflorum were normal, only 2 cases were larger. With clinical manifestation,22 cases （ 55% ） of patients were classified as hepatocellular, 8 cases （ 20% ） as cholestatic type and 10 cases （25 % ） as mixed type. The most clinical manifestations were acratia, fatigue anorexia, urine jaundice, and two eases with ascites, one case with upper gastrointestal hemorrhage were also found. The lab tests of liver functions showed increased levers of TBIL and ALT. In 40 bases ,38 patients were curable, and 2 died. Conclusion Peroral ploygonum multiflorum may cause liver injury, even cause acute hepatic failure, therefore peroral ploygonum muhiflorum should be used carefully for patients having base liver diseases or the elderly.