Samenuk David, Link Mark S, Homoud Munther K, Contreras Robert, Theoharides Theoharis C, Wang Paul J, Estes N A Mark
Division of Cardiology, New England Medical Center, Boston, MA 02111, USA.
Mayo Clin Proc. 2002 Jan;77(1):12-6. doi: 10.4065/77.1.12.
To evaluate possible cardiovascular toxic effects associated with use of dietary supplements containing ma huang, an herbal source of ephedrine.
We reviewed the comprehensive database Adverse Reaction Monitoring System of the Food and Drug Administration, which included clinical records, investigative reports, and autopsy reports related to ma huang use. The main outcome measurements were stroke, myocardial infarction, and sudden death.
From 1995 to 1997, 926 cases of possible ma huang toxicity were reported to the Food and Drug Administration. In 37 patients (23 women and 14 men with a mean +/- SD age of 43 +/- 13 years), use of ma huang was temporally related to stroke (in 16), myocardial infarction (in 10), or sudden death (in 11). Autopsies performed in 7 of the 11 patients who experienced sudden death showed a normal heart in 1, coronary atherosclerosis in 3, and cardiomyopathies in 3. In 36 of the 37 patients, use of ma huang was reported to be within the manufacturers' dosing guidelines.
Analysis of the 37 patients indicates the following findings: (1) ma huang use is temporally related to stroke, myocardial infarction, and sudden death; (2) underlying heart or vascular disease is not a prerequisite for ma huang-related adverse events; and (3) the cardiovascular toxic effects associated with ma huang were not limited to massive doses. Although the pathogenesis of the cardiac toxic effects of ma huang remains incompletely defined, available observational and circumstantial evidence indicates that use of the substance may be associated with serious medical complications.
评估使用含有麻黄（一种麻黄碱草药来源）的膳食补充剂可能产生的心血管毒性作用。
我们查阅了食品药品管理局的综合数据库不良反应监测系统，其中包括与麻黄使用相关的临床记录、调查报告和尸检报告。主要观察指标为中风、心肌梗死和猝死。
1995年至1997年，向食品药品管理局报告了926例可能的麻黄毒性病例。在37例患者（23名女性和14名男性，平均年龄±标准差为43±13岁）中，麻黄的使用与中风（16例）、心肌梗死（10例）或猝死（11例）在时间上相关。在11例猝死患者中的7例进行了尸检，结果显示1例心脏正常，3例有冠状动脉粥样硬化，3例有心肌病。在37例患者中的36例中，据报告麻黄的使用在制造商的给药指南范围内。
对这37例患者的分析表明以下发现：（1）麻黄的使用与中风、心肌梗死和猝死在时间上相关；（2）潜在的心脏或血管疾病不是麻黄相关不良事件的先决条件；（3）与麻黄相关的心血管毒性作用不限于大剂量。尽管麻黄心脏毒性作用的发病机制仍未完全明确，但现有的观察性和间接证据表明，该物质的使用可能与严重的医学并发症有关。
