中草药致药物性肝损害的临床特点与病理分析

Analysis of clinical and pathological characteristics in Chinese herbal drug-induced hepatitis patients

目的以西药为对照,分析中草药致药物性肝炎的临床与病理特点。方法回顾性分析临床诊断药物性肝损害66例,男29例,女37例,年龄8～65岁。全部患者经肝脏穿刺活检病理学诊断,肝组织细胞角蛋白(CK)、HBsAg免疫组织化学染色,记录用药史及肝脏生化指标。结果药物性肝损害中中草药(包括中成药)所致32例,占48.5%;中西药合用所致7例,药物种类以治疗月经失调、骨关节病及皮肤病为主,占43.8%;西药所致27例,占40.9%,以解热镇痛药、抗精神病药、抗生素为主,占74%。致药物性肝损害以肝细胞型为主,中草药占56.3%,西药占51.9%。中、西药引起的肝损害临床类型及临床表现差异无统计学意义。免疫组化显示,CK阳性21例(31.8%),全部病例肝组织HBsAg为阴性。结论中草药是近年来导致药物性肝损害的重要原因,临床特点及肝脏病理与西药相似,要高度重视中草药的安全性。

Objective To analyse the clinical and pathological characteristics in Chinese herbal drug-induced hepatitis patients.Methods Sixty-six drug-induced hepatitic patients were retrospectively analysed.Male/female was 29/37,the average age was 41.27 years old.All patients were received liver biopsy for pathological diagnosis,immunohistochemistry staining for CK and HBsAg.The detailed clinical data,including drug history,liver biochemical data were recorded.Results Chinese herbal medicine（including proprietary）-induced hepatitic patients was 32,accounting for 48.5%.7 cases had combination of Chinese and Western medicines.Major drugs were for treatment menstrual disorders,bone and joint diseases and skin diseases,accounting for 43.8%.Western drug-induced hepatitic patients was 27,accounting for 40.9%.Major were anti-inflammatory,anti-psychotics drugs,antibiotics,accounting for 74%.The type of liver cell injury was more common in Chinese herbal drug-induced hepatitis,accounting for 56%,similarity with western drug-induced hepatitis（51.8%）.Immunohistochemistry staining showed CK-positive in 21 cases（31.8%）,all cases of liver tissue HBsAg was negative.Conclusions Chinese herbal drug-induced hepatitis is the main cause of drug-induced liver disease.No difference in clinical and pathological characteristics between Chinese herbal and western drug-induced liver injury are observed.safety of Chinese herbal drug should be cautious in clinical setting.