【摘要】 目的:了解含马兜铃酸中成药、中草药引起泌尿系损害的特点。方法:收集近5年就诊并随访的各类含马兜铃酸中药泌尿系损害病人123例,其中服甘露消毒丸者80例。分析患者的临床表现和肾活检结果。结果:中药肾脏损害的临床类型主要有3种:非少尿型急肾衰(12例)、肾小管酸中毒(14例)及慢性肾小管间质性肾病(97例),病理主要表现为急性肾小管坏死或慢性间质性肾脏损害。11例病人确诊为泌尿系移行上皮细胞癌,伴慢性肾小管间质性肾病,均与甘露消毒丸相关。结论:短期大剂量服用含马兜铃酸中药可以引起急性肾小管坏死,长期间断小剂量服用该药可导致严重的慢性肾小管间质损害或肾小管酸中毒,甚至可引起泌尿系肿瘤。更多还原

【Abstract】 Objective:To investigate the clinical and pathological features of urothelial lesions induced by Chinese herbs containing Aristolochic acid. Methods:Examinations were performed in 123 cases with urothelial impairments induced by Chinese herbs containing Aristolochic acid,80 of them caused by Ganluxiaoduwan. Clinicopathologic characteristics was analyzed. Results:Three types of renal injuries were found in these 123 cases: acute renal failure without oligonuia(12 cases),chronic tubulointerstitial nephropathy(97 cases)and renal tubular acidosis(14 cases). The main pathological change of acute renal disease was acute tubular necrosis; and denaturation or disappearance of renal tubular epithelial cells and intensive or multifocal interstitial fibrosis with renal tubular atrophy,were observed in renal tissue of chronic patients. The conditions of cases who have taken Ganluxiaoduwan were much more severe than those of other(sP<0.001). In addition,there were 11 urothelial malignancy among all the cases,of whom all had taken Ganluxiaoduwan for a long time. Conclusion:Urothelial lesions induced by Chinese herbs containing Aristolochic acid are much more than we used to know. In most cases,aristolochic acid is the main reason. Taking a large dose of this kind of herbs for a short period may lead to acute tubular necrosis,and for a long time intermittently or continuously may cause serious tubulointerstitial nephropathy or renal tubular acidosis,even urothelial carcinomas.更多还原