警惕中药致药物性肝损伤

目的分析4例服用过相同中药的急性肝损伤患者的病因，以加深对中药引起的肝损伤的认识。方法对有相同服药史的4例急性肝损伤患者的，临床资料进行回顾性分析，根据服药史、临床表现、肝功能、血清标志物、肝穿病理活检及停药后的治疗效果综合判断，并用两个国际上权威的药物性肝损伤诊断标准进行评分。结果结合实验室检查及辅助检查。该4例患者可排除甲型肝炎、乙型肝炎、丙型肝炎、丁型肝炎、戊型肝炎的可能，并进一步排除了EB病毒和巨细胞病毒感染所致的肝炎、自身免疫性肝病、酒精性肝病、胆系疾病所致肝损伤、遗传代谢性疾病等肝病。用两个药物性肝损伤的诊断标准评分为6～8分，诊断为“很有可能”药物性肝损伤。结论通常认为无毒、无副作用的中药制剂也可为引起肝损伤重要原因．应予以重视。

The Origin of Four Patients with Acute Liver Injury

Objective To explore the origin of 4 patients with acute liver injury and call for attention on the risk of drug-induced liver injury with Chinese herbal medicine. Methods Four acute liver injury patients, who had received the same Chinese herbal medicine shortly before, were retrospectively studied based on the history of drug-taking, clinical manifestations, liver function, serum markers of virus hepatitis, and hepatic biopsy if possible. Diagnosis of all patients was done according to the two scoring systems of RUCAM and DDWJ-C respectively. Results All of the patients were excluded other cause of liver injury. The scores of all patients were 6 to 8 evaluated with the two scoring systems, and probably drug-induced liver injury was diagnosed. Conclusion Chinese herbal medicine may be an important cause of drug-induced liver injury. Monitoring the change of liver function is necessary during the treatment with Chinese herbal medicine.