中草药相关肝损伤的管理与治疗

孙鑫; 罗琼; 杨涛; 刘成海

doi:10.12449/JCH240806

中草药相关肝损伤的管理与治疗

DOI: 10.12449/JCH240806

孙鑫^{1a, 2},
罗琼^1a,
杨涛^{1b, 2},
刘成海^{1a, 2, 3, , ,}

1a.
上海中医药大学附属曙光医院肝病研究所，上海 201203
1b.
上海中医药大学附属曙光医院心血管病研究所，上海 201203
2.
上海市中医临床重点实验室，上海 201203
3.
肝肾疾病病证教育部重点实验室，上海 201203

基金项目:

国家中医药管理局高水平中医药重点学科建设项目 (zyyzdxk-2023060);

上海市中医药事业发展三年行动计划 (ZY（2018-2020）-CCCX-5001);

上海市科学技术委员会科技创新行动计划医学创新研究专项 (20Z21900100);

上海市临床重点专科建设项目 (shslczdzk01201)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：孙鑫负责资料收集和撰写论文；罗琼参与资料收集和整理；杨涛负责指导撰写和修改论文；刘成海负责拟定写作思路、指导撰写文章并最后定稿。

详细信息

通信作者:
刘成海， chenghailiu@hotmail.com （ORCID： 0000-0002-1696-6008）

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出版历程
- 收稿日期: 2024-06-15
- 录用日期: 2024-07-05
- 出版日期: 2024-08-25

Management and treatment of herb-induced liver injury

Xin SUN^{1a, 2},
Qiong LUO^1a,
Tao YANG^{1b, 2},
Chenghai. LIU^{1a, 2, 3
, ,
,}

1a.
Institute of Liver Diseases，Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China
1b.
Institute of Cardiovascular Disease，Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine，Shanghai 201203，China
2.
Shanghai Key Laboratory of Traditional Chinese Clinical Medicine，Shanghai 201203，China
3.
Key Laboratory of Liver and Kidney Diseases，Ministry of Education，Shanghai 201203，China

Research funding:

High-level Key Discipline Construction Project from State Administration of Traditional Chinese Medicine of China (zyyzdxk-2023060);

Shanghai TCM Development Three-Year Action Plan Project (ZY（2018-2020）-CCCX-5001);

Shanghai Science and Technology Innovation Action Plan Medical Innovation Research Special Project (20Z21900100);

Shanghai Key Specialty of Traditional Chinese Clinical Medicine (shslczdzk01201)

摘要

摘要: 由于我国中草药产品应用形式多样，使用人群广泛，用药情况复杂，近年来中草药相关肝损伤等不良反应事件频发，为进一步科学认识中草药相关肝损伤，规范其风险管理与防治措施，本文结合近年的临床研究进展与相关经验，对中草药相关肝损伤的风险管理、临床评价、预防及治疗展开论述。在中药研发生产、上市后的临床应用等多环节，建立涉及中药产品质量控制、患者安全教育、临床医师合理用药、定期监测、分级分型治疗等全方位的中草药相关肝损伤的管控体系，对于预防和处理肝损伤等不良反应事件非常重要，为中草药临床安全合理用药提供参考和借鉴。
- 中草药 /
- 化学性与药物性肝损伤 /
- 治疗学
Abstract: Due to the diverse application forms of Chinese herbal medicine products， the wide range of users， and the complex conditions of medication in China， adverse events including herb-induced liver injury （HILI） occur frequently in recent years. In order to further understand HILI and standardize its risk management and prevention and treatment measures， this article discusses the risk management， clinical evaluation， prevention， and treatment of HILI based on related clinical research advances and experience in recent years. In the multiple links of traditional Chinese medicine including production and clinical application after marketing， the establishment of a comprehensive control system is of great importance for the prevention and treatment of HILI and other adverse events， involving product quality control， patient safety education， rational drug use by clinicians， regular monitoring， and graded and classified treatment， which provides a reference for the rational and safe clinical use of Chinese herbal medicine in the future.
- Drugs， Chinese Herbal /
- Chemical and Drug Induced Liver Injury /
- Therapeutics

HTML全文

表 1 HILI药物治疗主要机制

Table 1. The main mechanisms of drug therapy for HILI

药物类别	药物名称	作用机制
保护肝细胞	N-乙酰半胱氨酸（NAC）	清除氧自由基
	甘草制剂	抗炎、抗氧化
	双环醇	抗炎、抗氧化
	多烯磷脂酰胆碱	增加肝细胞膜稳定性
	水飞蓟素	增加肝细胞膜稳定性、抗氧化
抗胆汁淤积	熊去氧胆酸	促进胆汁排泄
抗胆汁淤积	腺苷蛋氨酸	促进胆汁排泄、抗氧化
免疫抑制剂	激素	免疫抑制、抗炎
特殊药物	肝素	抗凝血
	去纤苷	促进纤维蛋白溶解
注：（1）对肝细胞损伤型HILI，可选用以降低ALT和/或AST为主的NAC（短疗程静脉注射NAC不推荐用于儿童）、甘草酸制剂、双环醇、水飞蓟素、多烯磷脂酰胆碱等抗炎保肝药治疗。（2）对胆汁淤积型HILI，可选用以降低ALP和/或GGT为主的熊去氧胆酸、腺苷蛋氨酸治疗。（3）对混合型HILI，可选择一种肝细胞保护剂加一种抗胆汁淤积药物联合治疗。（4）对于其他特殊类型的HILI，如含吡咯烷类生物碱等中药引起的肝窦阻塞综合征或肝小静脉闭塞症的肝血管损伤型HILI，在排除禁忌证后应尽早使用低分子肝素等抗凝药物，中-重度肝窦阻塞综合征HILI患者也可使用去纤苷治疗；何首乌等中药引起的特异质型HILI，在予以适当剂量和疗程的糖皮质激素治疗的同时，还应对症采取止吐药、止痒药和补液等支持性治疗^［5］。

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