Dağ Muhammed Said, Aydınlı Musa, Oztürk Zeynel Abidin, Türkbeyler Ibrahim Halil, Koruk Irfan, Savaş Muhammed Cemil, Koruk Mehmet, Kadayıfçı Abdurrahman
Department of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
Turk J Gastroenterol. 2014 Feb;25(1):41-5. doi: 10.5152/tjg.2014.4486.
BACKGROUND/AIMS: Drug-induced liver injury (DILI) is common worldwide and has a potentially fatal outcome. It accounts for more than half of the cases of acute liver failure in the United States. Herb-induced liver injury (HILI) is a less documented condition but a growing problem. We present here the clinical characteristics and outcome of patients with drug- and herb-induced liver injury from our center.
In this 4-year retrospective study, 82 patients in whom there was a causal or highly probable relationship between herbal medicine or drug use and liver disease are presented.
The mean age of patients was 43.1±14.8 years; sexual distribution was 53 females and 29 males. The major cause of hepatotoxicity was drugs (87.8%), with herbal medicine accounting for 12.2%. The leading causative agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1%), followed by antibiotics (19.5%). The pattern of hepatotoxicity was hepatocellular in 35 patients (42.6%), mixed in 28 (34.1%), and cholestatic in 19 patients (23.1%). Teucrium polium (known popularly as felty germander), which is a traditionally used herbal medicine of the Labiatae family in our region, was the most common cause of herb-induced liver injury and responsible in 7 of 10 herbal hepatotoxic cases. Acute liver failure developed in 3 patients (two patients related with flurbiprofen and diclofenac and one patient due to an isoniazid-rifampicin combination).
Antibiotics and NSAIDs were the most common etiologic agents for drug-induced liver injury. Surprisingly, herbs follow these groups of drugs and must be questioned more carefully.
背景/目的：药物性肝损伤（DILI）在全球范围内都很常见，且可能导致致命后果。在美国，它占急性肝衰竭病例的一半以上。草药性肝损伤（HILI）记录较少，但问题日益严重。我们在此介绍本中心药物和草药性肝损伤患者的临床特征及转归。
在这项为期4年的回顾性研究中，呈现了82例草药或药物使用与肝病之间存在因果关系或高度可能因果关系的患者。
患者的平均年龄为43.1±14.8岁；性别分布为女性53例，男性29例。肝毒性的主要原因是药物（87.8%），草药占12.2%。主要致病药物是非甾体抗炎药（NSAIDs）（23.1%），其次是抗生素（19.5%）。肝毒性模式为肝细胞型35例（42.6%），混合型28例（34.1%），胆汁淤积型19例（23.1%）。绵毛石蚕（俗称毡毛石蚕）是我们地区唇形科传统使用的草药，是草药性肝损伤最常见的原因，10例草药性肝毒性病例中有7例与之有关。3例患者发生急性肝衰竭（2例与氟比洛芬和双氯芬酸有关，1例因异烟肼-利福平联合用药）。
抗生素和NSAIDs是药物性肝损伤最常见的病因。令人惊讶的是，草药仅次于这些药物类别，必须更仔细地询问。
