中国的DILI西药，比草药损伤贡献更大

StephenW

Western medicine, more so than herbal medicine, contributes to DILI in China

Zhu Y, et al. J Gastroenterol Hepatol. 2016:doi:10.1111/jgh.13323.
October 10, 2016

   
In China, Western medicine may contribute more to drug-induced liver injury than Chinese herbal medicine, according to findings published in the Journal of Gastroenterology and Hepatology.

“The causal relationship between Chinese herbal medicine and liver injury is much complex, and the clinical characteristics of DILI caused by Chinese herbal medicine differ from those caused by Western medicine,” researchers from the China Military Institute of Chinese Medicine, and colleagues wrote. “In this study, [Chinese herbal medicine] was considered as an important but not the most common cause of DILI in China.”

Zhu and colleagues retrospectively studied 1,985 patients with DILI. The mean age of patients in the study was 44 years (range, 0.7-89) with 96.1% of patients older than 18 years. Eight hundred seventy were exclusively on WM, 563 patients were exclusively on CHM and the remainder had taken a combination of the two medicines.

“The characteristics of DILI in China are different from those in Western countries because of the different medication systems, diverse lifestyles, and race-related distinct genetic backgrounds, especially considering the widespread use of [Chinese herbal medicine] in China,” the researchers wrote.

According to researchers, 256 patients were diagnosed with chronic DILI:

    112 had been treated with Western medicine (atorvastatin was the most common medication linked to DILI);
    74 had been treated with a combination of medicines (VitC-yin-qiao tablet was the most common known medication); and
    70 had been treated with Chinese herbal medicine (an herbal decoction with unknown substances was the most common remedy employed).

Sixty-four patients died:

    27 had been treated with Chinese herbal medicine
    24 had been treated with Western medicine (norfloxacin was the most common medication used); and
    13 had been treated with a combination of medicines, with each taking a unique combination.

Eleven patients underwent a liver transplant:

    seven were on Western medicine, with each taking a unique remedy;
    two were on Chinese herbal medicine (they both took an herbal decoction with unknown substances); and
    two were on a combination of medicines (one took ketoconazole with an herbal decoction with unknown substances for acne and the other took a combination of acitretin, methotrexate and bai-dian-feng).

The remaining 1,651 patients received a “good” prognosis once the agents causing the DILI were cleared from their system and the patients underwent treatment, according to researchers.

The study was not without its limitations, researchers wrote.

“This …. single-center and retrospective survey and was limited by potential selection bias because all of the cases were hospitalized patients, which led to a poor outcome and low presentation in the general population,” researchers wrote. “Thus, there is a need for multicenter and prospective researches to investigate herbal hepatotoxicity and to find the distinctive characteristics of DILI caused by Chinese herbal medicine, and further efforts are needed to study the accurate causal relationship between Chinese herbal medicine and liver injury.” – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.

StephenW

西药，比草药更重要，有助于中国的DILI

Zhu Y，et al。 J Gastroenterol Hepatol。 2016：doi：10.1111 / jgh.13323。
2016年10月10日
中国的DILI西药，比草药损伤贡献更大
   
根据“胃肠病学与肝病学杂志”发表的研究结果，在中国，西医可能比中草药对药物性肝损伤贡献更大。

中国中医研究院研究人员和同事写道：“中草药与肝损伤的因果关系非常复杂，中草药引起的DILI的临床特征与西医所致的不同。 “在这项研究中，[中草药]被认为是中国DILI的一个重要但不是最常见的原因。

Zhu和他的同事回顾性研究了1985例DILI患者。研究中患者的平均年龄为44岁（范围为0.7-89岁），96.1％的患者年龄大于18岁。八百七十只完全在WM，563名患者只在CHM，其余的两种药物的组合。

“DILI在中国的特点与西方国家不同，因为不同的药物系统，多样的生活方式和种族相关的独特的遗传背景，特别是考虑到[中草药]在中国的广泛使用，”研究人员写道。

根据研究人员，256名患者被诊断为慢性DILI：

    112被西医治疗（阿托伐他汀是与DILI相关的最常见的药物）;
    74被用药物联合治疗（VitC阴阴片是最常见的已知药物）;和
    70用中草药治疗（用未知物质的草药煎剂是最常用的治疗方法）。

64例患者死亡：

    27人接受中草药治疗
    24名患者接受西药治疗（诺氟沙星是最常用的药物）;和
    13被用一种药物的组合治疗，每种药物采取独特的组合。

11例患者接受了肝移植：

    七个在西医，每个采取独特的补救;
    两个中草药（他们都用未知物质进行草药汤）;和
    两个是联合药物（一个使用酮康唑与草药煎剂与未知物质的痤疮，另一个采取阿维A，甲氨蝶呤和白芍的组合）。

根据研究人员，一旦导致DILI的药剂从其系统中清除并且患者接受治疗，剩余的1,651例患者接受“良好”预后。

研究人员写道，研究不是没有限制。

“这个 …。单中心和回顾性调查，并受潜在选择偏倚的限制，因为所有的病例都是住院患者，这导致了一般人群的结果不佳和低表达。 “因此，有必要进行多中心和前瞻性研究来调查草药的肝毒性，并找到由中草药引起的DILI的独特特征，需要进一步努力研究中草药与肝损伤之间的准确因果关系。 - by Janel Miller