本文選題：中草藥　切入點：肝損傷　出處：《中國中藥雜志》2017年03期

【摘要】：針對白鮮皮可能導(dǎo)致肝損傷的問題,該文對1例典型的單獨服食白鮮皮粉末導(dǎo)致肝損傷病例進(jìn)行臨床和實驗室系統(tǒng)研究。按照《中草藥相關(guān)肝損傷臨床診療指南》推薦的整合證據(jù)鏈方法對該病例進(jìn)行診斷研究。通過臨床病史、生化學(xué)和影像學(xué)等檢查,排除基礎(chǔ)疾病以及病毒性、自身免疫性、酒精性等易混淆肝病對診斷的影響;通過服藥史調(diào)查,排除其他藥物對診斷的影響,該患者僅服食1種藥物,懷疑該患者為"白鮮皮粉末"導(dǎo)致藥物性肝損傷。進(jìn)一步按照《中國藥典》對患者服食藥物進(jìn)行質(zhì)量檢查,符合白鮮皮項下規(guī)定;采用DNA條形碼鑒定,ITS2序列BLAST比對,與植物白鮮Dictamnus dasycarpus相似度為100%;檢測外源性有害物質(zhì),重金屬、農(nóng)殘、微生物毒素均未超過相關(guān)標(biāo)準(zhǔn)的規(guī)定;采用液相高分辨質(zhì)譜聯(lián)用儀及Agilent Fake TCM-Drugs數(shù)據(jù)庫檢查,未發(fā)現(xiàn)化學(xué)藥物添加。綜上,確定該病例為單獨服用白鮮皮粉末(15 g/日,超過藥典規(guī)定用量)導(dǎo)致藥物性肝損傷。該文按照《中草藥相關(guān)肝損傷臨床診療指南》,從臨床到實驗室系統(tǒng)檢查,確認(rèn)了1例單獨服食白鮮皮粉末致藥物性肝損傷的典型病例,為后續(xù)研究白鮮皮及其相關(guān)制劑的肝損傷風(fēng)險提供了直接和可靠證據(jù)。
[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.
【作者單位】： 承德醫(yī)學(xué)院;中國人民解放軍第302醫(yī)院全軍中醫(yī)藥研究所;中國人民解放軍第302醫(yī)院中西醫(yī)結(jié)合肝病診療與研究中心;中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院藥用植物研究所;
【基金】：國家“重大新藥創(chuàng)制”科技重大專項(2015ZX09501-004-001-008) 國家公益性行業(yè)專項(201507004-04)
【分類號】：R575

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本文編號：1656450