中药导致急性肝损伤临床研究

A clinical study on cases with traditional Chinese medicine induced liver injury

目的探讨中药所致急性肝损伤的临床特点。方法制定标准化的药物性肝损伤病案调查表,采用病例登记和随访,以及RUCAM评分系统,从急性药物性肝损伤患者中筛选出中药导致急性肝损伤相关病例,分析中药所致肝损伤的类型、临床表现、肝损伤严重程度等。结果在132例中药导致急性肝损伤相关病例中,男性59例,女性73例,平均年龄(51.6±17.5)岁。肝细胞型肝损伤107例,胆汁淤积型肝损伤20例,混合型肝损伤5例。轻度肝损伤10例(7.6%),中度肝损伤104例(78.8%),重度肝损伤16例(12.1%),致命性肝损伤2例(1.5%)。导致急性肝损伤的中药种类繁多,大多数药物系含有多种中药成分(26.5%),或具体药物成分不详的中药(56.8%)。结论中药导致肝损伤以肝细胞型为主,少数病例为重症或致死性,临床医生需要重视中药肝毒性。

Objective To investigate the clinical characteristics of cases with acute traditional Chinese medicine (TCM)induced liver injury.Methods We drew up the standardized case report forms of drug-induced liver injury,then filtered the clinical records of cases with acute TCM-induced liver injury from drug-induced liver injury cases by using standardized registration,follow-up and RUCAM,and analyzed the injury types,clinical presentation,severity grading of drug-induced liver injury.Results Among the evaluated 132 cases, there were 59 males and 73 females.The average age was (51.6 ±17.5)years .107 patients were classified as hepatocellular injury, 20 patients cholestatic injury,and 5 patients mixed injury.There were 10 patients whose severity grading of liver injury was mild (grade 1),104 patients moderate (grade 2),16 patients severe (grade 3),and 2 patients fatal (grade 4).TCMcategories causing acute liver injury varied.More than half of the medicine were mixture of much unknown TCM.Conclusions These results suggested that the hepa-tocellular injury was the predominant clinical pattern in acute TCM-induced liver injury.A small number of patients showed severe to fa-tal liver injury.Therefore,doctors should attach importance to TCMhepatotoxicity.