乌干达住院患者前瞻性队列中的草药使用及相关疑似药物不良反应
Herbal medicine use and linked suspected adverse drug reactions in a prospective cohort of Ugandan inpatients.
作者信息
Kiguba Ronald, Ononge Sam, Karamagi Charles, Bird Sheila M
机构信息
Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda.
出版信息
BMC Complement Altern Med. 2016 May 26;16:145. doi: 10.1186/s12906-016-1125-x.
BACKGROUND
Clinical history-taking can be employed as a standardized approach to elucidate the use of herbal medicines and their linked suspected adverse drug reactions (ADRs) among hospitalized patients. We sought to identify herbal medicines nominated by Ugandan inpatients; compare nomination rates by ward and gender; confirm the herbs' known pharmacological properties from published literature; and identify ADRs linked to pre-admission use of herbal medicines.
METHODS
Prospective cohort of consented adult inpatients designed to assess medication use and ADRs on one gynaecological and three medical wards of 1790-bed Mulago National Referral Hospital. Baseline and follow-up data were obtained on patients' characteristics, including pre-admission use of herbal medicines.
RESULTS
Fourteen percent (26/191) of females in Gynaecology nominated at least one specific herbal medicine compared with 20 % (114/571) of inpatients on medical wards [20 % (69/343) of females; 20 % (45/228) of males]. Frequent nominations were Persea americana (30), Mumbwa/multiple-herb clay rods (23), Aloe barbadensis (22), Beta vulgaris (12), Vernonia amygdalina (11), Commelina africana (7), Bidens pilosa (7), Hoslundia opposita (6), Mangifera indica (4), and Dicliptera laxata (4). Four inpatients experienced 10 suspected ADRs linked to pre-admission herbal medicine use including Commelina africana (4), multiple-herb-mumbwa (1), or unspecified local-herbs (5): three ADR-cases were abortion-related and one kidney-related.
CONCLUSIONS
The named herbal medicines and their nomination rates generally differed by specialized ward, probably guided by local folklore knowledge of their use. Clinical elicitation from inpatients can generate valuable safety data on herbal medicine use. However, larger routine studies might increase the utility of our method to assess herbal medicine use and detect herb-linked ADRs. Future studies should take testable samples of ADR-implicated herbal medicines for further analysis.
背景
临床病史采集可作为一种标准化方法，用以阐明住院患者使用草药的情况及其相关的疑似药物不良反应（ADR）。我们试图确定乌干达住院患者提及的草药；比较不同病房和性别的提及率；从已发表的文献中确认这些草药已知的药理特性；并确定与入院前使用草药相关的ADR。
方法
对同意参与的成年住院患者进行前瞻性队列研究，旨在评估拥有1790张床位的穆拉戈国家转诊医院一个妇科病房和三个内科病房的用药情况及ADR。获取了患者特征的基线和随访数据，包括入院前使用草药的情况。
结果
妇科病房14%（26/191）的女性患者提及了至少一种特定草药，而内科病房的住院患者中有20%（114/571）提及[女性患者中20%（69/343）；男性患者中20%（45/228）]。常见提及的草药有鳄梨（30例）、蒙布瓦/多草药泥棒（23例）、库拉索芦荟（22例）、甜菜（12例）、扁桃斑鸠菊（11例）、非洲鸭跖草（7例）、三叶鬼针草（7例）、对叶肾茶（6例）、芒果（4例）和疏花水蓑衣（4例）。4名住院患者出现了10例与入院前使用草药相关的疑似ADR，包括非洲鸭跖草（4例）、多草药蒙布瓦（1例）或未指明的当地草药（5例）：3例ADR病例与流产有关，1例与肾脏有关。
结论
所提及的草药及其提及率通常因专科病房而异，这可能是受当地关于其用途的民间知识的指导。从住院患者中进行临床问诊可以生成关于草药使用的有价值的安全性数据。然而，更大规模的常规研究可能会提高我们评估草药使用和检测与草药相关的ADR的方法的实用性。未来的研究应该采集涉及ADR的草药的可检测样本进行进一步分析。
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