疑似千里光类药物致药物性肝损伤1例分析

A case of suspected drug induced liver injury caused by Senecio Scandens

目的 分析千里光类药物与药物性肝损伤的关系,为临床用药安全提供参考。方法 对1例服用可疑千里光类药物后导致肝窦阻塞综合征患者进行分析;比对千里光碱(一种吡咯生物碱)标准品与患者血液、尿液样本色谱图,根据因果关系评价表(roussel uclaf causality assessment method,RUCAM)和《中草药相关肝损伤临床诊疗指南》分析评估可疑药物与肝损伤的相关性。结果 该患者肝损伤表现为肝窦阻塞综合征,患者尿样本中可能存在千里光碱的类似物或代谢物,RUCAM量表评分为8分,判断可疑服用药物与肝损伤存在相关性。结论 服用中药时,慎重评估有无千里光类药物成分,出现肝损伤时,应及时停药并进行针对性检查和治疗。

Objective To analyze the relationship between Senecio scandens and drug induced liver injury,so as to provide reference for clinical safe drug use.Methods A case of hepatic sinusoidal obstruction syndrome after taking suspected senecio herb was reported.The chromatograms of the standard senecilline,which is one kind of Pyrrolizidine Alkaloids,with the patient’s blood and urine samples were compared,and the correlation between the suspected drug and liver injury was assessed according to the Roussel Uclaf Causality Assessment Method(RUCAM) and guidelines for clinical diagnosis and treatment of herb-induced liver injury.Results The patient’s liver injury was manifested as hepatic sinusoidal obstruction syndrome.The patient’s urine sample propably contained the analogues or metabolites of senecilline.The RUCAM scale score was eight points,judging that there was a correlation between suspected herbal medicine and liver injury.Conclusion When taking traditional Chinese medicine,carefully evaluate whether there are Senecio scandens.If liver injury occurs,the drug should be discontinued promptly and targeted investigations and treatment should be carried out.