Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA.
BMC Complement Med Ther. 2021 Mar 13;21(1):91. doi: 10.1186/s12906-021-03251-z.
Complementary and alternative medicine use among Americans is prevalent. Originating in India, Ayurvedic medicine use in the United States has grown 57% since 2002. CAM accounts for a significant proportion of drug induced liver injury in India and China, but there have been only three reports of drug induced liver injury from Ayurvedic medications in the U.S. We report three cases of suspected Ayurvedic medication associated liver injury seen at a Southern California community hospital and review literature of Ayurvedic medication induced liver injury.
Three patients presented with acute hepatocellular injury and jaundice after taking Ayurvedic supplements for 90-120 days. First patient took Giloy Kwath consisting solely of Tinospora cordifolia. Second patient took Manjishthadi Kwatham and Aragwadhi Kwatham, which contained 52 and 10 individual plant extracts, respectively. Third patient took Kanchnar Guggulu, containing 10 individual plant extracts. Aminotransferase activities decreased 50% in < 30 days and all 3 patients made a full recovery. Roussel Uclaf Causality Assessment Method (RUCAM) scores were 7-8, indicating probable causality. These products all contained ingredients in other Ayurvedic and traditional Chinese medicines with previously reported associations with drug induced liver injury.
These patients highlight the risk of drug induced liver injury from Ayurvedic medications and the complexity of determining causality. There is a need for a platform like LiverTox.gov to catalog Ayurvedic ingredients causing liver damage.
补充和替代医学在美国的应用非常普遍。阿育吠陀医学起源于印度，自 2002 年以来，其在美国的应用增长了 57%。CAM 在印度和中国造成了相当一部分的药物性肝损伤，但在美国只有三起因阿育吠陀药物引起的药物性肝损伤报告。我们报告了在南加州社区医院就诊的三例疑似与阿育吠陀药物相关的肝损伤病例，并回顾了阿育吠陀药物引起的肝损伤的文献。
三例患者在服用阿育吠陀补充剂 90-120 天后出现急性肝细胞损伤和黄疸。第一例患者服用的是仅由印度人参组成的 Giloy Kwath。第二例患者服用的是 Manjishthadi Kwatham 和 Aragwadhi Kwatham，分别含有 52 和 10 种植物提取物。第三例患者服用的是 Kanchnar Guggulu，含有 10 种植物提取物。氨基转移酶活性在 <30 天内降低了 50%，所有 3 例患者均完全康复。Roussel Uclaf 因果关系评估方法 (RUCAM) 评分分别为 7-8 分，表明可能存在因果关系。这些产品都含有其他阿育吠陀和中药中已报道与药物性肝损伤相关的成分。
这些患者突出了阿育吠陀药物引起药物性肝损伤的风险，以及确定因果关系的复杂性。需要像 LiverTox.gov 这样的平台来记录导致肝损伤的阿育吠陀成分。
