Amadi Cecilia Nwadiuto, Orisakwe Orish Ebere
Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria.
Toxics. 2018 Apr 17;6(2):24. doi: 10.3390/toxics6020024.
The last few decades have seen a rise in the use of herbal supplements, natural products, and traditional medicines. However, there are growing concerns related to the safety and toxicities of these medicines. These herbal medicines are associated with complications such as liver damage with a high incidence of mortalities and morbidities. Clinical manifestations range from asymptomatic cases with abnormal liver functions tests to sudden and severe liver failure necessitating liver transplantation. This work aimed to review the etiology, risk factors, diagnosis, clinical manifestations and selected clinical case reports of herbal hepatotoxicity in developing nations. PubMed and Google Scholar searches were undertaken to identify relevant literature. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches. Little data exists on clinical cases of herb-induced liver injury in some developing countries such as Nigeria, as most incidences are either not reported to health care providers or reports from hospitals go unpublished. Studies in Nigeria have highlighted a possible correlation between use of herbs and liver disease. In Uganda, and association between the use of traditional herbal medicine with liver fibrosis in HIV-infected and non-HIV patients was demonstrated. Reports from China have revealed incidences of acute liver failure as a result of herbal medicine use. The actual incidence and prevalence of HILI in developing nations remain largely unknown due to both poor pharmacovigilance programs and non-application of emerging technologies. Improving education and public awareness of the potential risks of herbals and herbal products is desirable to ensure that suspected adverse effects are formally reported. There is need for stricter regulations and pre-clinical studies necessary for efficacy and safety.
在过去几十年中，草药补充剂、天然产品和传统药物的使用有所增加。然而，人们对这些药物的安全性和毒性的担忧也与日俱增。这些草药与诸如肝损伤等并发症相关，肝损伤的死亡率和发病率都很高。临床表现从肝功能检查异常的无症状病例到需要进行肝移植的突发严重肝衰竭不等。这项工作旨在回顾发展中国家草药肝毒性的病因、危险因素、诊断、临床表现及部分临床病例报告。通过在PubMed和谷歌学术上进行检索以识别相关文献。此外，我们浏览了主要文章和综述文章的参考文献列表，以识别未通过电子检索获取的出版物。在一些发展中国家，如尼日利亚，关于草药引起肝损伤的临床病例数据很少，因为大多数病例要么未向医疗服务提供者报告，要么医院的报告未发表。尼日利亚的研究强调了草药使用与肝病之间可能存在的关联。在乌干达，已证明在感染艾滋病毒和未感染艾滋病毒的患者中，使用传统草药与肝纤维化之间存在关联。中国的报告显示了因使用草药导致急性肝衰竭的病例。由于药物警戒计划不完善以及新兴技术未得到应用，发展中国家草药引起肝损伤的实际发病率和患病率在很大程度上仍然未知。提高教育水平和公众对草药及草药产品潜在风险的认识，以确保疑似不良反应能得到正式报告，这是很有必要的。需要有更严格的法规以及进行疗效和安全性所需的临床前研究。
