Hagen Rachael, Wu George Y
Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA.
J Clin Transl Hepatol. 2025 Sep 28;13(9):754-765. doi: 10.14218/JCTH.2025.00180. Epub 2025 Aug 18.
Khat () is a plant native to East Africa and the Arabian Peninsula, chewed for its stimulant effects by millions worldwide. Its sympathomimetic properties, primarily due to cathinone and other pyrrolizidine alkaloids, resemble those of amphetamine. Emerging reports have linked khat use to the development of autoimmune hepatitis, supported by elevated autoimmune markers, characteristic liver biopsy findings, and clinical resolution following khat cessation or a prompt response to corticosteroid therapy without recurrence. In this review, we aimed to update knowledge on both acute and chronic forms of khat-associated AIH. We discuss cathinone metabolism, pharmacokinetics, and proposed mechanisms of khat hepatotoxicity. We also provide an updated synthesis of published cases of khat-associated autoimmune hepatitis, including our calculated Roussel-Uclaf Causality Assessment Method analysis and the simplified Hennes AIH score where data were available. Case presentations, diagnostic criteria, histopathological findings, and treatment approaches are summarized to help guide management.
巧茶（）是一种原产于东非和阿拉伯半岛的植物，全球数百万人咀嚼它以获得其刺激效果。其拟交感神经特性主要归因于卡西酮和其他吡咯里西啶生物碱，类似于苯丙胺。新出现的报告将巧茶的使用与自身免疫性肝炎的发展联系起来，这得到了自身免疫标志物升高、特征性肝活检结果以及停用巧茶后临床缓解或对皮质类固醇治疗迅速反应且无复发的支持。在本综述中，我们旨在更新关于巧茶相关自身免疫性肝炎急性和慢性形式的知识。我们讨论了卡西酮代谢、药代动力学以及巧茶肝毒性的拟议机制。我们还提供了已发表的巧茶相关自身免疫性肝炎病例的最新综述，包括我们计算的鲁塞尔 - 优克福因果关系评估方法分析以及在有数据时的简化亨内斯自身免疫性肝炎评分。总结了病例呈现、诊断标准、组织病理学发现和治疗方法，以帮助指导管理。
