中药导致急性肝损伤临床研究

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。

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

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).TCM categories causing acute liver injury varied.More than half of the medicine were mixture of much unknown TCM.Conclusions These results suggested that the hepatocellular injury was the predominant clinical pattern in acute TCM-induced liver injury.A small number of patients showed severe to fatal liver injury.Therefore,doctors should attach importance to TCM hepatotoxicity.