超量服用三叶青致糖尿病和血细胞减少

Diabetes mellitus and hemocytopenia induced by overdose of Tetrastigma hemsleyanum

1例76岁女性患者肺癌切除术并行化疗结束后自行泡服三叶青15 g/d。用药3个月后患者出现乏力、口干症状。4个月后出现白细胞和血红蛋白减少,空腹血糖和糖化血红蛋白升高,并进行性加重。服药6个月后,白细胞计数2.8×10^(9)/L,血红蛋白88 g/L,红细胞计数3.05×10^(12)/L;空腹血糖10.01 mmol/L,糖化血红蛋白6.93%。诊断为糖尿病、白细胞减少、贫血,考虑可能与三叶青有关。嘱患者停用三叶青,给予中药汤剂治疗,2个月后血细胞恢复正常,空腹血糖6.08 mmol/L,糖化血红蛋白6.10%。《中药志》中三叶青的每日规定用量为3~9 g,本例患者的糖尿病和血细胞减少可能与超剂量长时间服用该药有关。

A 76-year-old female patient took soaking water of Tetrastigma hemsleyanum 15 g daily by herself after lung cancer resection and chemotherapy.After 3 months of medication,the patient developed fatigue and dry mouth.After 4 months of medication,decrease of white blood cells and hemoglobin and increase of fasting blood glucose and glycosylated hemoglobin appeared and were gradually aggravated.After 6 months of medication,the white blood cell count was 2.8×10^(9)/L,hemoglobin was 88 g/L,red blood cell count was 3.05×10^(12)/L,fasting blood glucose was 10.01 mmol/L,and glycosylated hemoglobin was 6.93%.Diabetes mellitus,leukopenia,and anemia were diagnosed,which were considered to be related to Tetrastigma hemsleyanum.The patient was asked to stop drinking the soaking water of Tetrastigma hemsleyanum and the traditional Chinese medicine decoction was given.Two months later,the patient′s blood cells returned to normal,fasting blood glucose was 6.08 mmol/L,and glycosylated hemoglobin was 6.10%.The prescribed daily dose of Tetrastigma hemsleyanum in Chinese Medicine Record is 3-9 g.Diabetes mellitus and hemocytopenia in the patient might be related to overdose and long-time use of the drug.