基于整合证据链的白鲜皮粉末致肝损伤病例实验研究

发布时间：2018-03-24 03:13

  本文选题：中草药　切入点：肝损伤　出处：《中国中药杂志》2017年03期

【摘要】：针对白鲜皮可能导致肝损伤的问题,该文对1例典型的单独服食白鲜皮粉末导致肝损伤病例进行临床和实验室系统研究。按照《中草药相关肝损伤临床诊疗指南》推荐的整合证据链方法对该病例进行诊断研究。通过临床病史、生化学和影像学等检查,排除基础疾病以及病毒性、自身免疫性、酒精性等易混淆肝病对诊断的影响;通过服药史调查,排除其他药物对诊断的影响,该患者仅服食1种药物,怀疑该患者为"白鲜皮粉末"导致药物性肝损伤。进一步按照《中国药典》对患者服食药物进行质量检查,符合白鲜皮项下规定;采用DNA条形码鉴定,ITS2序列BLAST比对,与植物白鲜Dictamnus dasycarpus相似度为100%;检测外源性有害物质,重金属、农残、微生物毒素均未超过相关标准的规定;采用液相高分辨质谱联用仪及Agilent Fake TCM-Drugs数据库检查,未发现化学药物添加。综上,确定该病例为单独服用白鲜皮粉末(15 g/日,超过药典规定用量)导致药物性肝损伤。该文按照《中草药相关肝损伤临床诊疗指南》,从临床到实验室系统检查,确认了1例单独服食白鲜皮粉末致药物性肝损伤的典型病例,为后续研究白鲜皮及其相关制剂的肝损伤风险提供了直接和可靠证据。
[Abstract]:In view of the problem that the skin of fresh white may cause liver injury, A clinical and laboratory study of a typical case of liver injury caused by taking white fresh skin powder alone was carried out in this paper. The method of integrating evidence chain recommended by the guidelines for Clinical diagnosis and treatment of Hepatic injury related to Chinese Herbal Medicine was used. Through the clinical history, Biochemical and imaging examinations were used to exclude the influence of liver diseases such as basic diseases, viral, autoimmune and alcoholic diseases on the diagnosis of liver diseases. By investigating the history of medication, excluding the influence of other drugs on the diagnosis, the patient took only one drug. It was suspected that the patient was a "white fresh skin powder", which caused drug-induced liver injury. The quality of the drug taken in accordance with the Chinese Pharmacopoeia was further checked, which was in accordance with the requirements under the white fresh skin. The DNA bar code was used to identify the BLAST comparison of the ITS2 sequence. The similarity between Dictamnus dasycarpus and plant Dictamnus is 100; the detection of exogenous harmful substances, heavy metals, agricultural residues and microbial toxins does not exceed the relevant standards; the high resolution liquid chromatography mass spectrometry and Agilent Fake TCM-Drugs database are used to check the contents of exogenous harmful substances, heavy metals, agricultural residues and microbial toxins. No addition of chemical drugs was found. In summary, it was determined that the case was treated with white fresh skin powder for 15 g / d alone. In accordance with the guidelines for the Clinical diagnosis and treatment of Hepatic injury related to Chinese Herbal Medicine, a typical case of drug-induced liver injury caused by taking white fresh skin powder alone was confirmed from clinical to laboratory examination. It provides direct and reliable evidence for further study on the liver injury risk of fresh fresh skin and its related preparations.
【作者单位】： 承德医学院;中国人民解放军第302医院全军中医药研究所;中国人民解放军第302医院中西医结合肝病诊疗与研究中心;中国医学科学院北京协和医学院药用植物研究所;
【基金】：国家“重大新药创制”科技重大专项(2015ZX09501-004-001-008) 国家公益性行业专项(201507004-04)
【分类号】：R575

【参考文献】

中国期刊全文数据库 前7条

1 肖小河;李秀惠;朱云;王伽伯;李丽;张涛;刘成海;孙克伟;杨华升;郭玉明;;中草药相关肝损伤临床诊疗指南[J];中国中药杂志;2016年07期

2 贺蕾艳;郭瑶雪;李春;邓晔;张U_智;彭文兴;;药物性肝损伤生物标志物研究进展[J];药学学报;2015年08期

3 李春雨;李晓菲;涂灿;李娜;马致洁;庞晶瑶;贾歌刘畅;崔鹤蓉;游云;宋海波;杜晓曦;赵艳玲;王伽伯;肖小河;;基于内毒素模型的何首乌特异质肝损伤评价[J];药学学报;2015年01期

4 呼丹;刘悦;樊星;吴纯启;王全军;丁日高;;药物性肝损伤研究概述[J];国际药学研究杂志;2014年02期

5 秦林;张少华;岳晓莉;;谈有毒中药的使用原则[J];山东中医杂志;2007年11期

6 王秀娟;许利平;王敏;;常用中药及复方制剂的肝毒性[J];首都医科大学学报;2007年02期

7 常章富;论人体因素对中药有毒无毒的影响[J];中国中药杂志;1997年09期

【共引文献】

中国期刊全文数据库 前10条

1 郭秀彩;张紫萍;邓英光;赵博欣;;4种水飞蓟素单体对鹅膏毒蕈中毒大鼠肝损伤的保护作用[J];今日药学;2017年01期

2 菅丽萍;朱靖;吴媛媛;;东北林业大学新生体检转氨酶升高原因分析[J];中国校医;2017年01期

3 宁静;马怀雷;;BHMT用于检测急性中毒性肝损伤的价值[J];国际检验医学杂志;2017年01期

4 王红林;汪晓燕;俞春莺;;26例小儿药物性肝损伤的临床特点探讨[J];临床医药实践;2017年01期

5 谢铮铮;梁瑶;孙路路;;抗肿瘤药物肝毒性评价及在肝功能受损患者中的剂量调整[J];中国临床药理学杂志;2016年23期

6 马U，

本文编号：1656450