Department of Hepatobiliary-Pancreatic Surgery, Cell Transplantation Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
BMC Complement Med Ther. 2022 Mar 8;22(1):61. doi: 10.1186/s12906-022-03549-6.
Gynura segetum (GS) is widely used in medical care and in community settings in China as the herbal remedy. It is widely thought to have antiphlogistic properties and pain relief in traditional Chinese medicine. It has been reported that GS can cause chronic drug-induced liver injury (DILI), manifested as hepatic sinusoid obstruction syndrome (HOSO). But case reports of acute DILI developing acute liver failure (ALF) due to GS are extremely rare.
We report a case of a 63-year-old female patient with hepatolithiasis for more than 6 years. There were no deterioration of liver function and no history of viral liver disease, autoimmune liver disease, blood transfusion or surgical allergy before operation. ALF and grade II liver encephalopathy occurred after partial hepatectomy. To follow up the medical history, the patient has been taking GS (Tusanqi) for a year and a half. The causality assessment was done by the updated Roussel Uclaf Causality Assessment Method, and the possibility of DILI caused by GS as highly probable for the score was 6 points. Excluding other causes, a diagnosis of DILI-associated ALF was established. After symptomatic support and artificial liver support system (ALSS) treatment, the clinical symptoms and signs of the patients were significantly improved. After discharge, the liver function of the patients returned to normal.
Based on this rare case of severe liver injury, we recommend that timely prevention, identification, and appropriate management of DILI is essential for patients with a history of taking GS and other hepatotoxic drugs, and careful monitoring of liver function for patients with DILI could avoid ALF as far as possible.
三叶鬼针草（GS）在中国的医疗保健和社区环境中被广泛用作草药。在传统中医中，它被广泛认为具有抗炎和止痛的特性。据报道，GS 可引起慢性药物性肝损伤（DILI），表现为肝窦阻塞综合征（HOSO）。但因 GS 引起急性 DILI 进而发展为急性肝衰竭（ALF）的病例报告极为罕见。
我们报告了一例 63 岁女性患者，患有胆石症超过 6 年。在手术前，肝功能无恶化，无病毒性肝病、自身免疫性肝病、输血或手术过敏史。部分肝切除术后发生 ALF 和 II 级肝性脑病。随访病史，患者一直服用 GS（土三七）一年半。使用更新的 Roussel Uclaf 因果关系评估方法进行因果关系评估，GS 引起 DILI 的可能性评分为 6 分，高度可能。排除其他原因后，诊断为 DILI 相关性 ALF。经对症支持和人工肝支持系统（ALSS）治疗后，患者的临床症状和体征明显改善。出院后，患者肝功能恢复正常。
基于这例罕见的严重肝损伤病例，我们建议对于有 GS 和其他肝毒性药物服用史的患者，及时预防、识别和适当管理 DILI 至关重要，对 DILI 患者进行肝功能密切监测可尽可能避免 ALF。
