Steenkamp V, Stewart M J, Zuckerman M
Department of Chemical Pathology, South African Institute for Medical Research, University of the Witwatersrand, Johannesburg.
Ther Drug Monit. 2000 Jun;22(3):302-6. doi: 10.1097/00007691-200006000-00011.
In a study carried out in two hospitals in South Africa the authors identified 20 children suffering from hepatic veno-occlusive disease thought to be caused by the administration of traditional remedies. The predominant clinical presentation was ascites of various degrees and hepatomegaly. There was a high morbidity and mortality in the young infants, and in those cases who survived and were followed up the clinical pattern was one of progression to cirrhosis and portal hypertension. Pyrrolizidine alkaloid poisoning is one of the causes of the veno-occlusive disease. Therefore there is a need for objective confirmation of this. In four of our cases an on-admission urine specimen was available and in all of these a simple colorimetric screening test confirmed the presence of pyrrolizidine alkaloids. The other cases were admitted from peripheral hospitals and clinics and urine was not obtained until after 72 h, a time at which the levels of pyrrolizidines in urine were below the limit of sensitivity of the screening test. The screening method is helpful for the detection of acute ingestion of pyrrolizidines in large amounts, but is not sufficiently sensitive for the detection of chronic ingestion of smaller amounts. Nevertheless, in those patients who have hepatomegaly and ascites a positive finding of pyrrolizidines is important and may remove the necessity for expensive and invasive investigative measures.
在南非两家医院开展的一项研究中，作者识别出20名患有肝静脉闭塞病的儿童，该病被认为是由服用传统药物所致。主要临床表现为不同程度的腹水和肝肿大。年幼婴儿的发病率和死亡率很高，在存活并接受随访的病例中，临床症状表现为逐渐发展为肝硬化和门静脉高压。吡咯里西啶生物碱中毒是肝静脉闭塞病的病因之一。因此有必要对此进行客观证实。在我们的4例病例中，入院时可获取尿液样本，所有这些样本通过简单的比色筛查试验均证实存在吡咯里西啶生物碱。其他病例是从周边医院和诊所转诊而来，直到72小时后才获取尿液，而此时尿液中吡咯里西啶的水平低于筛查试验的灵敏度限值。该筛查方法有助于检测大量急性摄入的吡咯里西啶，但对于检测少量慢性摄入的灵敏度不足。尽管如此，对于那些有肝肿大和腹水的患者，吡咯里西啶检测呈阳性很重要，可能无需采取昂贵且有创的检查措施。
