Philips Cyriac Abby, Paramaguru Rajaguru, Joy Adarsh K, Antony K L, Augustine Philip
Department of Hepatology and Liver Transplant Medicine, PVS Memorial Hospital, Kochi, 682 025, India.
Department of Pathology, PVS Memorial Hospital, Kochi, 682 025, India.
Indian J Gastroenterol. 2018 Jan;37(1):9-17. doi: 10.1007/s12664-017-0815-8. Epub 2018 Feb 24.
Ayurvedic and herbal medicines (AHM) are known to cause varying degrees of drug-induced liver injury (DILI). Clinical, biochemical, histological spectrum and outcomes of AHM linked to severe DILI are not well studied.
Out of 1440 liver disease patients, 94 were found to have a severe liver injury and associated AHM intake. Thirty-three patients were suspected to have AHM-DILI on Roussel Uclaf Causality Assessment Scoring Method. Forty-seven and 30 of retrieved AHM samples were analyzed for heavy metals and hepatotoxic volatile organic compounds (hVOCs), respectively. Eleven patients ingested AHM from unregistered traditional healers (UTH). Clinicopathological outcomes were analyzed in 27 patients (who underwent liver biopsy) and outcomes with respect to chemical analyses were studied in 33 patients.
Males predominated (70.4%) with mean age 46.9±15.8 years. Mean follow up was 119.2±81.4 days. The median duration of drug intake was 28 days (10 - 84). Five patients died (18.5%). Hepatic encephalopathy, hypoalbuminemia, and hepatic necrosis were significantly associated with mortality (p < 0.005). Arsenic and mercury ingestion was significantly associated with death (p < 0.005). hVOCs were detected in more than 70% of samples. AHM intake from UTH was associated with higher mortality.
Adequate regulation and scrutiny regarding AHM use among the general population is an unmet need. Early liver biopsy after clinical identification of at-risk patients can expedite definitive treatment with a liver transplant.
已知阿育吠陀药物和草药（AHM）会导致不同程度的药物性肝损伤（DILI）。与严重DILI相关的AHM的临床、生化、组织学特征及转归尚未得到充分研究。
在1440例肝病患者中，94例被发现有严重肝损伤且有AHM摄入史。采用鲁塞尔乌克拉夫因果关系评估评分法，33例患者被怀疑患有AHM-DILI。分别对47份和30份回收的AHM样本进行重金属和肝毒性挥发性有机化合物（hVOCs）分析。11例患者服用了来自未注册传统治疗师（UTH）的AHM。对27例接受肝活检的患者的临床病理转归进行分析，对33例患者进行化学分析相关转归的研究。
男性占主导（70.4%），平均年龄46.9±15.8岁。平均随访时间为119.2±81.4天。药物摄入的中位持续时间为28天（10 - 84天）。5例患者死亡（18.5%）。肝性脑病、低白蛋白血症和肝坏死与死亡率显著相关（p < 0.005）。砷和汞摄入与死亡显著相关（p < 0.005）。超过70%的样本中检测到hVOCs。服用来自UTH的AHM与更高的死亡率相关。
对普通人群使用AHM进行充分监管和审查是一项未得到满足的需求。在临床识别高危患者后尽早进行肝活检可加快肝移植的确定性治疗。
