草藥是否比處方藥對肝毒性更大？

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草藥是否比處方藥對肝毒性更大？

    Vincent L. Chen & Robert J. Fontana

Hepatology International 第 15 卷，第 1301–1304 頁（2021）引用本文

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在這個問題上，黃等人。報告了一項前瞻性研究的結果，該研究對 1297 名因草藥和膳食補充劑 (HDS)（HDS 誘導的肝損傷；HILI）或常規處方藥 (DILI) 而導致肝損傷的台灣患者進行了研究 [1]。 DILI 是一個眾所周知的難以確定的診斷，即使只有一種純化的可疑藥物，因為肝損傷的發生在很大程度上與使用劑量或持續時間無關，並且可能與不同的表型和肝損傷的嚴重程度有關。特異質 DILI 的發生率僅為萬分之一到十萬分之一，被認為是通過涉及宿主代謝和/或適應性免疫途徑的罕見遺傳多態性介導的。 HILI 佔台灣病例的 22%，並且與顯著更高的 MELD 評分和隨訪期間的死亡率相關（12.6% 對 8.0%）。值得注意的是，與 DILI 病例（38 天對 28 天）相比，使用 HDS 產品到肝損傷發作的潛伏期也顯著更長，這可能是由於延遲將草藥產品識別為肝損傷的原因或 HDS 消費者的不情願求醫[2]。在美國，與傳統藥物相比，後一種假設與 HDS 產品導致的急性肝衰竭患者的持續較差結果有關 [3, 4]。作者還發現，與食用加工的商業 HDS 產品的人相比，“本土種植的”粗製 HDS 產品是最常見的草藥產品類型，與食用加工的、由台灣許可供應商規定的商業 HDS 產品的人相比，死亡率更高。 .

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Are herbals more hepatotoxic than prescription medications?

    Vincent L. Chen & Robert J. Fontana

Hepatology International volume 15, pages 1301–1304 (2021)Cite this article

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In this issue, Huang et al. report the results of a prospective study of 1297 Taiwanese patients with liver injury attributed to either herbal and dietary supplements (HDS) (HDS-induced liver injury; HILI) or conventional prescription medications (DILI) [1]. DILI is a notoriously difficult diagnosis to establish even when there is only a single purified suspect drug since the onset of liver injury is largely independent of the dose or duration of use and may be associated with varying phenotypes and severity of liver injury. With an incidence of only 1 in 10,000 to 1 in 100,000 medication exposed individuals, idiosyncratic DILI is believed to be mediated via rare genetic polymorphisms involving host metabolic and/ or adaptive immune pathways. HILI accounted for 22% of the Taiwanese cases and was associated with significantly higher MELD scores at presentation and mortality during follow-up (12.6% vs 8.0%). Of note, the latency of HDS product use to liver injury onset was also significantly longer compared to the DILI cases (38 vs 28 days) which may be due to delayed recognition of the herbal product as a cause of liver injury or reluctance of HDS consumers to seek medical care [2]. The latter hypothesis has previously been implicated for the consistently poorer outcomes seen in acute liver failure patients attributed to HDS products compared to conventional medications in the United States [3, 4]. The authors also found that crude “home grown” HDS products were the most commonly implicated type of herbal products and independently associated with a higher mortality rate compared to those who consumed processed, commercial HDS products that are federally regulated and prescribed by licensed providers in Taiwan.

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