C.A.R., Cambridge, UK; Hammersmith Hospital, London, UK.
Breakspear Medical Group, Hemel Hempstead, Hertfordshire, UK.
Med Hypotheses. 2019 Dec;133:109402. doi: 10.1016/j.mehy.2019.109402. Epub 2019 Sep 19.
The dried root of the angiosperm Scutellaria baicalensis, also known as Chinese skullcap or Baikal skullcap, is widely used in traditional Chinese medicine, Korean traditional medicine and as a nutritional supplement; several studies have indicated that both the supplement and some of its ingredients may have clinically beneficial actions. However, the National Institutes of Health official guidance states that the use of Scutellaria "has been implicated in rare instances of clinically apparent liver injury" and that "the onset of symptoms and jaundice occurred within 6-24 weeks of starting skullcap, and the serum enzyme pattern was typically hepatocellular", with marked increases in serum alanine transaminase, aspartate transaminase, alkaline phosphatase and bilirubin levels. Careful perusal of all such published case reports showed that in each case the patient was concurrently taking at least one other supplement which had an established association with hepatic dysfunction. The authors hypothesised that long-term supplementation with Scutellaria baicalensis does not lead to hepatic dysfunction. The aim of this study was to test this hypothesis by assessing liver function before and after starting supplementation with Scutellaria baicalensis. Pre- and post-supplementation serum assays of alanine transaminase, aspartate transaminase, alkaline phosphatase and bilirubin were carried out in 17 patients (16 female) of average age 38.6 (standard error 4.4) years who had each taken 1335 mg dried root daily for an average of 444 (71) days. The mean baseline versus follow-up values for each liver function test were: alanine transaminase: 25.7 (2.6) IU/L v. 25.1 (1.7) IU/L; aspartate transaminase: 22.1 (1.1) IU/L v. 23.5 (1.3) IU/L; alkaline phosphatase: 63.7 (4.6) IU/L v. 63.3 (3.9) IU/L; and bilirubin: 6.1 (0.6) μM v. 6.0 (0.7) μM. None of these changes was statistically significant; indeed, three of the four parameters showed a non-significant decrease over time. Furthermore, none manifested clinical symptoms or signs of hepatic dysfunction during Scutellaria supplementation. These results suggest that daily intake of a relatively high level of Scutellaria baicalensis for over a year is not associated with any biochemical or clinical evidence of hepatic dysfunction. Indeed, Scutellaria baicalensis has been shown in murine experiments to have hepatoprotective actions.
被子植物黄芩的干燥根，又称黄芩或北黄芩，在中国传统医学、韩国传统医学和营养补充剂中广泛使用；一些研究表明，补充剂及其一些成分可能具有临床有益作用。然而，美国国立卫生研究院的官方指南指出，黄芩的使用“在罕见的情况下与明显的肝损伤有关”，“症状和黄疸在开始服用黄芩后 6-24 周内出现，血清酶谱通常为肝细胞性”，血清丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶和胆红素水平显著升高。仔细查阅所有此类已发表的病例报告显示，在每例病例中，患者同时服用至少一种其他与肝功能障碍相关的补充剂。作者假设，长期补充黄芩不会导致肝功能障碍。本研究的目的是通过评估开始补充黄芩前后的肝功能来检验这一假设。在 17 名（16 名女性）平均年龄为 38.6（标准误差 4.4）岁的患者中进行了补充黄芩前后的血清丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶和胆红素检测，每位患者每天服用 1335mg 干根，平均 444（71）天。每个肝功能测试的基线与随访值的平均值分别为：丙氨酸转氨酶：25.7（2.6）IU/L 与 25.1（1.7）IU/L；天冬氨酸转氨酶：22.1（1.1）IU/L 与 23.5（1.3）IU/L；碱性磷酸酶：63.7（4.6）IU/L 与 63.3（3.9）IU/L；胆红素：6.1（0.6）μM 与 6.0（0.7）μM。这些变化均无统计学意义；事实上，其中四个参数中有三个随时间呈非显著性下降。此外，在黄芩补充期间，没有任何患者出现肝功能障碍的临床症状或体征。这些结果表明，每天摄入相对高水平的黄芩超过一年与任何生化或临床证据的肝功能障碍无关。事实上，黄芩在鼠类实验中已被证明具有保肝作用。
