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題 名 | 中草藥腎病變=Chinese Herbs Nephropathy |
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作 者 | 林靜皓; 楊垂勳; | 書刊名 | 內科學誌 |
卷 期 | 13:6 2002.12[民91.12] |
頁 次 | 頁276-281 |
分類號 | 414.5 |
關鍵詞 | 中草藥腎病變; 馬兜鈴酸; 間質性腎炎; Chinese herb nephropthy; Aristolochic acid; Interstitial nephritis; |
語 文 | 中文(Chinese) |
中文摘要 | 中草藥腎病變的概念首先在1993年被提出,比利時的醫師報導年輕婦女服用含有中草藥成分的減肥藥後,發生快速進行性纖維化間質腎炎的病例。其典型的臨床表徵包括不明原因的腎衰竭,血壓正常或稍偏高,相對於腎功能不全之程度,貧血較嚴重,無或輕微蛋白尿,無顯著尿液沈渣。雖然停藥,腎功能仍快速惡化。腎臟的病理變化可見廣泛性的腎間質纖維化,腎小管嚴重萎縮或消失,腎間質組織少有細胞浸潤;腎絲球近乎完整,少數或腎絲球有缺血性基底膜皺縮。近半數的病例接後會發生泌尿道上皮惡性腫瘤。進一步植物生化分析,發現這些減肥藥含有馬兜鈴酸的成份。馬兜鈴酸是一種很強的腎毒性物質,並且具有致突變能力,因而馬兜鈴酸被認為是引發中草藥腎病變的主要物質。 中草藥腎病變的病例除了比利時的報告以外,在法國、西班牙、日本及英國也陸續被發現。在國內也發現不少相同病例,這些病人服用中草藥並不是為了減肥,有的是為了保健,有的是作為其他疾病的輔助治療,由於這些藥物的來源複雜,因此很難證寶馬兜鈴酸的角色。我們推測可能有其他無法獲知的植物毒性(phytotoxins)存在於藥物中,引起這種獨特的腎臟病變。臨床醫師應提高警覺性,防止民眾盲目濫用中草藥偏方,以避免悲劇的一再發生。 |
英文摘要 | Chinese herbs nephropathy(CHN) was first reported in 1993. A nephrologist found two young Belgian wo-men presented with rapidly progressive interstitial renal fibrosis following the introduction of Chinese herbs in a slimming regimen. The nephropathy is characterized by early, severe anemia, mild tubular proteinuria and normal arterial blood pressure. In most of cases, the renal failure progressed rapidly despite cessation of toxic exposure. The major pathologic findings show extensive, hypocellular interstitial fobrosis associated with atrophy and loss of renal tubules, predominantly located in the superficial cortex. Glomeruli are intact, a few glomeruli show partial ischemic wrinkling. Urothelial malignancy of the upper urinary tract develops subsequently in almost half of the patients. Further phytochemical analysis identify that the slimming regimen contained aristolochic acid(AA). Aristolochic acid is a known nephrotoxic agent and potent carcinogen in rodents. Aristolochic acid was supposed to induce the outbreak of interstitial nephropathy in Belgium. CHN is not only limited to an outbreak in Belgium. Some other cases have been reported in Canada, Germen, Australia and United Kingdoms. Patients with similar clinical and pathological features are also collected in Taiwan. These patients took herbal medicines for a variety of purpose, eg. slimming and beauty, health promotion or as adjuvant therapy for other disease. Because the herbal medicines were from different resources, it is difficult to identify the existence of aritolochic acid in the herbal medication consumed by these patients. It is possible there are other phytotoxins contained in the herbal regimen may cause the unique lesion. CHN is still under investigation. |
本系統中英文摘要資訊取自各篇刊載內容。