【摘要】 目的:分析患者服用何首乌及其相关制剂的原因、药物来源及其制剂所致药物性肝损伤(DILI)的临床表现、体征,探讨其影响患者预后的相关因素,以期减少或杜绝该药相关的DILI发生,改善患者临床结局。方法:收集2009年1月至2018年10月于重庆医科大学附属第二医院住院、有何首乌及其相关制剂服药史、诊断为DILI的病例。记录其服药原因、剂型、剂量、疗程及临床症状、生化指标、治疗、预后等情况,分析患者肝功能受损和预后的相关因素。结果:与何首乌相关的DILI病例183例,其中资料相对完整的140例,服用单味何首乌75例(53.6%),基层医生中药方剂29例(20.7%),中成药36例(25.7%)。服药时间最长150 d,最短1 d,平均28 d。临床分型:肝细胞损伤型132例(94.3%),胆汁淤积型和混合型各4例(2.9%)。DILI严重程度分级:1级33例(23.6%), 2级29例(20.7%), 3级28例(20.0%), 4级47例(33.5%), 5级3例(2.1%)。其中3级以上患者服用单味何首乌比例多,而且剂量大。服用中成药患者以轻中度病例为主,服中药方剂患者介于两者之间。多数患者在治疗7 d内各生化指标(ALT、AST、ALP)降低50%以上,治愈率97.9%。结论:何首乌引起DILI与药物使用的规范程度、剂量、疗程密切相关。轻中度患者临床治疗效果好,个别患者可出现严重后果,甚至死亡。因此,应该提高公众的认识水平,恰当用药,科学、规范使用何首乌及其相关制剂,最好在专科医生指导下用药,并在治疗过程中密切监测肝功能变化。在充分发挥何首乌药效的前提下保证用药安全性,减少不良事件的发生。更多还原

【Abstract】 Objective:By analyzing the reasons for taking the Polygonum multiflorum or its preparations,the source of the drug,the clinical manifestations,the signs of the drug-induced liver injury(DILI),we try to investigate the factors that affected the prognosis of DILI,and reduce or eliminate occurrence of the drug-induced liver injury and improve clinical outcomes.Methods:The data of the inpatients were collected at the Second Affiliated Hospital of Chongqing Medical University from January 2009 to october 2018. ALL of them had uesd Polygonum multiflorum or its preparations before the onset of DILI. The materials, such as the cause of taking medication,dosage form,dosage,course of treatment,clinical symptoms and signs,biochemical markers,treatment plan and prognosis,were recorded to find the risk factors of liver injury and prognosis. Results:Of the 183 LIDI patients who used Polygonum multiflorum or its preparation,there were 140 cases with relatively detail data,75(53.6%) with single Polygonum multiflorum,29 patients(20.7%) with Traditional Chinese medicine prescription,and 36 cases(25.7%) with Chinese patent medicine.The patients took the medicine from one day up to 150 days,with an average duration of 28 days.Clinical injury patterns were hepatocellular type 132 cases(94.3%),cholestatic and mixed type 4 cases,respectively(2.9%). 33 cases(23.6%) were at level 1 DILI severity rating,29 cases(20.7%) at level 2,28 cases(20.0%) at level 3,47 cases(33.5%) at level 4,and 3 cases(2.1%) at level 5. Among patients with grade 3 or above,the ratio of taking single regime Polygonum multiflorum was higher,and the dose was larger. Mild to moderate DILI cases were mainly in patients taking Chinese patent medicines group,and the severity of patients taking Traditional Chinese medicine prescription were between the two groups.In most patients,the biochemical markers(ALT,AST,LAP) were reduced by more than 50% within 7 days of treatment,and the cure rate was 97.9%.Conclusion:The severity of DILI caused by Polygonum multiflorum is closely related to the standardization degree,dosage,course of treatment of drug use. The curative effect of mild and moderate patients were good,but a few patients have serious consequences,even death. Therefore,the level of public awareness should be raised.Attach great importance to the appropriate use of Polygonum multiflorum or its preparations, preferably by a scientifically and standardize way with the guidance of specialists. Liver function changes need to be closely monitored in the course of treatment.We have to make good use of the advantage of Polygonum multiflorum or its preparations.guanrantee safty of drug use,and reduce the occurrence of adverse events.更多还原