Woolf G M, Petrovic L M, Rojter S E, Wainwright S, Villamil F G, Katkov W N, Michieletti P, Wanless I R, Stermitz F R, Beck J J, Vierling J M
Cedars-Sinai Medical Center, Los Angeles, California.
Ann Intern Med. 1994 Nov 15;121(10):729-35. doi: 10.7326/0003-4819-121-10-199411150-00001.
To describe the hepatotoxicity associated with ingestion of the Chinese herbal product Jin Bu Huan Anodyne Tablets (Lycopodium, serratum) and to propose possible mechanisms of injury.
Retrospective analysis.
Academic hepatology units and private practice facilities.
Seven previously healthy patients.
Clinical, laboratory, radiologic, and histologic studies.
Acute hepatitis occurred after a mean of 20 weeks (range, 7 to 52 weeks) of Jin Bu Huan ingestion and resolved in six patients within a mean of 8 weeks (range, 2 to 30 weeks); another patient is currently improving. Hepatitis was associated with symptoms of fever, fatigue, nausea, pruritus, and abdominal pain and with signs of jaundice and hepatomegaly. Biopsy specimens showed that one patient had hepatitis with eosinophils (consistent with a drug reaction) and the other had mild hepatitis, moderate fibrosis, and microvesicular steatosis. Decreasing the Jin Bu Huan dose in one patient improved liver test results. Reusing Jin Bu Huan in two other patients caused abrupt recrudescence of hepatitis.
Jin Bu Huan can cause liver injury. Although the hepatotoxic mechanisms are not defined, they may include hypersensitive or idiosyncratic reactions or direct toxicity to active metabolites. Hepatotoxicity caused by herbal products underscores the toxicity caused by herbal products underscores the importance of national surveillance programs and quality control of the manufacture of these products.
描述与服用中草药产品金不换止痛片（石松、锯齿石松）相关的肝毒性，并提出可能的损伤机制。
回顾性分析。
学术性肝病科和私人诊所。
7名既往健康的患者。
临床、实验室、放射学和组织学研究。
服用金不换平均20周（范围7至52周）后发生急性肝炎，6名患者平均8周（范围2至30周）内康复；另一名患者目前病情正在改善。肝炎伴有发热、乏力、恶心、瘙痒和腹痛症状以及黄疸和肝肿大体征。活检标本显示，1名患者为伴有嗜酸性粒细胞的肝炎（符合药物反应），另1名患者为轻度肝炎、中度纤维化和微泡性脂肪变性。1名患者减少金不换剂量后肝功能检查结果改善。另外2名患者再次服用金不换导致肝炎突然复发。
金不换可导致肝损伤。虽然肝毒性机制尚不清楚，但可能包括过敏或特异反应或对活性代谢产物的直接毒性。草药产品引起的肝毒性强调了国家监测计划和这些产品生产质量控制的重要性。
