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基于转化毒理学的中药致肝损伤的识别与早期诊断

[Identification and early diagnosis for traditional Chinese medicine-induced liver injury based on translational toxicology].

作者信息

Wang Jia-Bo, Xiao Xiao-He, Du Xiao-Xi, Zou Zheng-Sheng, Song Hai-Bo, Guo Xiao-Xin

出版信息

Zhongguo Zhong Yao Za Zhi. 2014 Jan;39(1):5-9.

Abstract

Recently traditional Chinese medicine (TCM)-induced liver injury has been an unresolved critical issue which impacts TCM clinical safety. The premise and key step to reduce or avoid drug-induced liver injury (DILI) is to identify the drug source of liver injury in early stage. Then the timely withdrawal of drug and treatment can be done. However, the current diagnosis of DILI is primarily governed by exclusive method relying on administering history supplied by patients and experience judgment from doctors, which lacks objective and reliable diagnostic indices. It is obvious that diagnosis of TCM-induced liver injury is especially difficult due to the complicated composition of TCM medication, as well the frequent combination of Chinese and Western drugs in clinic. In this paper, we proposed construction of research pattern and method for objective identification of TCM-related DILI based on translational toxicology, which utilizes clinical specimen to find specific biomarkers and characteristic blood-entering constituents, as well the clinical biochemistry and liver biopsy. With integration of diagnosis marker database, bibliographic database, medical record database and clinical specimen database, an integrative diagnosis database for TCM-related DILI can be established, which would make a transformation of clinical identification pattern for TCM-induced liver injury from subjective and exclusive to objective and index-supporting mode. This would be helpful to improve rational uses of TCM and promote sustainable development of TCM industry.

摘要

近年来,中药所致肝损伤一直是影响中药临床安全性的一个悬而未决的关键问题。减少或避免药物性肝损伤(DILI)的前提和关键步骤是早期识别肝损伤的药物来源。然后才能及时停药并进行治疗。然而,目前DILI的诊断主要依靠患者提供的用药史和医生的经验判断这种排他性方法,缺乏客观可靠的诊断指标。显然,由于中药成分复杂,以及临床中中西药联用频繁,中药所致肝损伤的诊断尤为困难。在本文中,我们提出构建基于转化毒理学的客观识别中药相关DILI的研究模式和方法,利用临床标本寻找特异性生物标志物和特征性入血成分,以及临床生化指标和肝活检。通过整合诊断标志物数据库、文献数据库、病历数据库和临床标本数据库,可以建立一个中药相关DILI的综合诊断数据库,这将使中药所致肝损伤的临床识别模式从主观排他性转变为客观指标支持模式。这将有助于提高中药的合理使用,促进中药产业的可持续发展。

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