Goyal Hemant, Rahman M Rubayat, Perisetti Abhilash, Shah Nihar, Chhabra Rajiv
Department of Medicine, Mercer University School of Medicine, Macon, Georgia.
Department of Internal Medicine, Texas Tech University, Lubbock, Texas.
Eur J Gastroenterol Hepatol. 2018 Nov;30(11):1283-1290. doi: 10.1097/MEG.0000000000001256.
The recent legalization of recreational marijuana use in some parts of the world, the discovery of new indications for the clinical application of cannabis, and the acceptance of the use of cannabis in practice has been paralleled by extensive research on the active components of cannabis and the endocannabinoid system within the human body. In this review, we evaluate the available evidence on cannabis and its constituents and the application of this evidence in clinical practice, focusing particularly on the liver and liver diseases. Constituents of cannabis, such as cannabidiol and Δ-tetrahydrocannabinol, have shown anti-inflammatory, antioxidant, and hepatoprotective effects both in in vitro and clinical studies, and appear to have potential in the symptom management and treatment of various liver diseases that were previously considered difficult to manage conservatively. In addition, the manipulation of the inherent endocannabinoid response system has found favor in many clinical fields and has generated considerable research and clinical interest. Moreover, evidence with regard to the adverse effects of marijuana use in liver diseases is weak, which has led to raise a question on the prior rules, with regard to a denial of liver transplantation to marijuana users. All in all, the recent trends in research, clinical experiences, as well as the legislature, has opened up new avenues towards the widespread clinical application of cannabis and its derivatives as well as modifiers of the components of the endocannabinoid system. More research is required to fully exploit these new evidences.
近期，世界上一些地区将娱乐性大麻使用合法化，大麻临床应用新适应症的发现，以及大麻在实际应用中的被接受，与此同时，针对大麻的活性成分和人体内的内源性大麻素系统也展开了广泛研究。在本综述中，我们评估了关于大麻及其成分的现有证据，以及该证据在临床实践中的应用，特别关注肝脏和肝脏疾病。大麻的成分，如大麻二酚和Δ-四氢大麻酚，在体外和临床研究中均显示出抗炎、抗氧化和肝脏保护作用，并且在之前被认为难以保守治疗的各种肝脏疾病的症状管理和治疗中似乎具有潜力。此外，对内在内源性大麻素反应系统的调控在许多临床领域受到青睐，并引发了大量研究和临床关注。此外，关于大麻使用对肝脏疾病不良影响的证据不足，这引发了对先前拒绝大麻使用者进行肝移植规定的质疑。总而言之，近期的研究趋势、临床经验以及立法，为大麻及其衍生物以及内源性大麻素系统成分调节剂的广泛临床应用开辟了新途径。需要更多研究来充分利用这些新证据。
