GMO, University of Health Sciences, Phnom Penh, Cambodia.
UMR 152 PharmaDev, Université de Toulouse, IRD, UPS, Nice, France.
PLoS One. 2023 Aug 10;18(8):e0288389. doi: 10.1371/journal.pone.0288389. eCollection 2023.
In Cambodia, traditional medicine was commonly described as being used by pregnant women at two time points: one month before birth and during early postpartum. The present study aims to describe traditional medicine consumption during postpartum phase for women enrolled in the TA PROHM study and to investigate the possible association between traditional medicine consumption and acute liver toxicity. An ethnobotanical survey was conducted in 2 groups of HBV-infected pregnant women (with and without postpartum hepatocellular injury) enrolled in the study. Hepatocellular injury was defined by having Alanine Aminotransferase (ALT) > 2.5 times the Upper Limit of Normal (ULN = 40 U/L) at the 6th week postpartum visit. Interviews were done using a standardized questionnaire. Plant samples were collected and later identified by two traditional healers. Chi-square test was used to find the association between hepatocellular injury and traditional medicine consumption or a specific plant species. In total, 75 women were enrolled and 52 (69.3%) used at least one traditional remedy composed of 123 different plants and 12 alcoholic macerations of porcupine stomach. Orally consuming at least one remedy with alcohol was significantly associated with hepatocellular injury (33% vs 13%, p = 0.034). Among the 123 plants species identified, four were found to be associated with hepatocellular injury, namely Amphineurion marginatum (Roxb.) D.J.Middleton [Apocynaceae] (p = 0.022), Selaginella tamariscina (P.Beauv.) Spring [Selaginellaceae] (p = 0.048), Mitragyna speciosa Korth. [Rubiaceae] (p = 0.099) and Tetracera indica (Christm. & Panz.) Merr. [Dilleniaceae] (p = 0.079). Consumption of traditional medicine in postpartum is a common practice for women enrolled in the TA PROHM study. Alcohol-based remedies may exacerbate the risk of acute hepatocellular injury in HBV-infected women already exposed to immune restoration. The complex mixtures of herbs need to be further evaluated by in vitro and in vivo studies.
在柬埔寨，传统医学通常被描述为在两个时间点被孕妇使用：分娩前一个月和产后早期。本研究旨在描述 TA PROHM 研究中纳入的产妇在产后阶段使用传统医学的情况，并调查传统医学使用与急性肝毒性之间的可能关联。在该研究中纳入的两组乙型肝炎病毒 (HBV) 感染孕妇（产后有肝细胞损伤和无肝细胞损伤）中进行了民族植物学调查。肝细胞损伤的定义为产后第 6 周就诊时丙氨酸氨基转移酶 (ALT) 高于正常上限 (ULN = 40 U/L) 的 2.5 倍。使用标准化问卷进行访谈。收集植物样本，由两位传统治疗师鉴定。使用卡方检验发现肝细胞损伤与传统医学使用或特定植物种类之间的关联。共有 75 名妇女被纳入研究，其中 52 名（69.3%）使用了至少一种由 123 种不同植物和 12 种豪猪胃酒精浸膏组成的传统疗法。至少使用一种含酒精的疗法与肝细胞损伤显著相关（33% vs 13%，p = 0.034）。在所鉴定的 123 种植物中，有 4 种与肝细胞损伤有关，分别为 Amphineurion marginatum (Roxb.) D.J.Middleton [夹竹桃科]（p = 0.022）、Selaginella tamariscina (P.Beauv.) Spring [卷柏科]（p = 0.048）、Mitragyna speciosa Korth. [茜草科]（p = 0.099）和 Tetracera indica (Christm. & Panz.) Merr. [使君子科]（p = 0.079）。参与 TA PROHM 研究的妇女在产后使用传统医学是一种常见做法。对于已经暴露于免疫恢复的 HBV 感染妇女，基于酒精的疗法可能会加剧急性肝细胞损伤的风险。需要进一步通过体外和体内研究评估草药的复杂混合物。
