常用抗风湿中草药肾毒性调查

Investigation of Nephrotoxicity of Antirheumatic Chinese Medicine

目的通过大数据技术研究细辛、泽泻、补骨脂和威灵仙这类被认为具有肾毒性的常用抗风湿中草药,在临床真实使用环境中是否具有肾毒性及与肾毒性的相关因素。方法查阅上海中医药大学附属龙华医院2005年5月20日至2016年10月1日期间,所有使用过上述药物的患者基本信息,以及用药前后的肾功能检查结果、配伍用药情况等共2046万条数据信息,在数据库解决方案搭建上,采用SQL软件从医院现有的各业务系统中调取相关数据,建立分析平台,从而实现大数据的分析。结果在配伍的情况下,四味药物肾毒性发生率分别为,细辛0.89%、泽泻1.32%、补骨脂1.12%、威灵仙1.70%。在单独使用的情况下,细辛肾毒性发生率为3.08%。四味药物的肾功能异常表现均以胱抑素C升高为主,约占异常人数的70%~76%,肾毒性发生率表现出随着患者年龄增长而升高的趋势。泽泻、补骨脂和威灵仙的肾毒性发生率随累计剂量增多而升高,而细辛未出现此情况。结论在临床真实使用环境中,在中医辨证论治的基础上,在君臣佐使配伍理论指导下使用细辛、泽泻、补骨脂和威灵仙这类具有'肾毒性'的药物是相对安全的。

Objective The use of big data technology to investigate whether the commonly used anti-rheumatic herbal medicines such as Asarum,Alisma,Psoralea,and Clematis,which are considered to have nephrotoxicity,are associated with nephrotoxicity in a clinically realistic environment.Methods The medical records of all the inpatients and outpatients who had used Asarum,Alisma,Psoralea and Clematis during 20 May 2005 to 1 October 2016 from Longhua Hospital have been searched.The information includes,prescriptions,all the renal function test results before and after medical care and the compatibility of other traditional Chinese medicine.Based on the database of Longhua Hospital,relevant information will be extracted from the existing operation systems of the hospital.The final purpose is to achieve the big data analysis process.Results In case of the compatibility of other herbs,the renal toxicity incidence of patients taking Asarum,Alisma,Psoralea,and Clematis was 0.89%,1.32%,1.12%,and 1.70%.In case of the none compatibility,the renal toxicity incidence of Asarum was 3.08%.In the patients who have abnormal renal function after the medicial care,the main characteristic of renal dysfunction was the increase of Cystatin C among the three renal function indexes,about 70%-76%.The rate of renal toxicity is rising with the age.The renal dysfunction of these herbs was rising with the cumulative dosage,except Asarum.Conclusion In the real clinical environment,on the basis of syndrome differentiation and treatment of traditional Chinese medicine,it is safe to use the combination theory of Asarum,Alisma,Psoralea,and Clematis.