Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University, Frankfurt/Main, Germany.
Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University, Frankfurt/Main, Germany.
Dig Liver Dis. 2014 Mar;46(3):264-9. doi: 10.1016/j.dld.2013.10.020. Epub 2013 Dec 5.
Positive re-exposure tests are diagnostic hallmarks for hepatotoxicity.
To test validity of positive re-exposures in herb induced liver injury.
We searched Medline database for cases of herb induced liver injury with positive re-exposures and analysed 34 cases for positive re-exposure test criteria of baseline alanine aminotransferase< 5N before re-exposure, and re-exposure alanine aminotransferase ≥ 2× baseline alanine aminotransferase. Re-exposure test was negative, if baseline alanine aminotransferase< 5N combined with re-exposure alanine aminotransferase< 2× baseline alanine aminotransferase, or if baseline alanine aminotransferase≥ 5N regardless of the re-exposure alanine aminotransferase including no available re-exposure alanine aminotransferase result.
In 21/34 cases (61.8%), criteria for a positive re-exposure were fulfilled, with negative tests in 6/34 cases (17.6%) or uninterpretable ones in 7/34 cases (20.6%). Confirmed positive re-exposure tests established potential of herb induced liver injury for Aloe, Chaparral, Chinese herbal mixtures, Chinese Jin Bu Huan, Chinese Syo Saiko To, Germander, Greater Celandine, Green tea, Kava, Mistletoe, Polygonum multiflorum, and Senna, with up to 4 case reports per herb.
Among 34 cases of herb-induced liver injury with initially reported positive re-exposure tests, 61.8% of the cases actually fulfilled established test criteria and provided firm diagnoses of herb induced liver injury by various herbs.
阳性再暴露试验是肝毒性的诊断标志。
检验草药肝损伤阳性再暴露试验的有效性。
我们检索了 Medline 数据库中具有阳性再暴露的草药肝损伤病例，并对 34 例病例进行了分析，以确定阳性再暴露试验的标准，即在再暴露前基线丙氨酸氨基转移酶（ALT）<5N，再暴露时 ALT≥2×基线 ALT。如果基线 ALT<5N 且再暴露 ALT<2×基线 ALT，或基线 ALT≥5N 且无论再暴露 ALT 如何，包括无法获得再暴露 ALT 结果，则再暴露试验为阴性。
在 34 例病例中，21 例（61.8%）符合阳性再暴露标准，6 例（17.6%）为阴性试验，7 例（20.6%）为无法解释的试验。确认的阳性再暴露试验确定了芦荟、金缕梅、中药混合物、金不换、四逆散、白毛夏枯草、绿茶、土大黄、卡瓦、槲寄生、何首乌和番泻叶等草药肝损伤的潜在可能性，每种草药的病例报告多达 4 例。
在 34 例最初报告阳性再暴露试验的草药肝损伤病例中，61.8%的病例实际上符合既定的试验标准，并通过各种草药明确诊断为草药性肝损伤。
