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植物中的吡咯里西啶类生物碱(pyrrolizidine alkaloids,PAs)是引致肝小静脉闭塞病的主要原因之一。美国、英国和我国等许多国家都有与含PAs植物或草药相关的肝小静脉闭塞病或肝损害的报道。全球约有6000余种植物含PAs,主要为4个科某些属的植物,即(1)菊科的千里光属、橐吾属、泽兰属、菊三七属和蜂斗菜属;(2)紫草科的所有属;(3)豆科的猪屎豆属;(4)兰科的羊耳蒜属。我国有38种中草药含PAs,常用的有12种:千里光、狗舌草、菊三七、款冬、佩兰、泽兰、山紫菀、紫草、天芥菜、野百合、猪屎豆、羊耳蒜。PAs本身的毒性极低,但其代谢物有肝毒性。PAs致肝毒性的摄入量,成人通常为每日数毫克至数百毫克,但WHO认为致肝小静脉闭塞病的每日最低摄入量为0.015mg/kg,即相当于70kg体重成人每天1mg。肝小静脉闭塞病的主要临床表现为顽固性腹水、黄疸、肝大。肝小静脉闭塞病尚无特效疗法,主要为对症、支持治疗。近年有报道用糖皮质激素或肝素治疗,但疗效和安全性尚待研究。作者认为,我国应加强含PAs植物致中毒的教育和监测。
Pyrrolizidine alkaloids (PAs) in plants are one of the main causes of hepatic venular occlusive disease. Many countries, such as the United States, the United Kingdom, and my country, have reports of hepatic venular occlusive disease or liver damage associated with PAs containing plants or herbs. There are about 6,000 species of plants in the world containing PAs, mainly four plants belonging to certain genera, namely (1) Trichosanton, Senecio, Eupatorium, Chrysanthemum and Butterburia; (2) All genera of comfrey; (3) Leguminosae genus; (4) Orchidaceae of Orchidaceae. China has 38 kinds of Chinese herbal medicine containing PAs, commonly used in 12 species: Senecio, Ragwort, chrysanthemum March, Coltsfoot, Perrin, Zeeland, Aster, Lithospermum, Hemlock, wild lily, pig crotalaria, ear garlic. PAs have very low toxicity, but their metabolites are hepatotoxic. PAs cause liver toxicity intake, adults usually daily milligrams to hundreds of milligrams, but the WHO that the minimum daily intake of liver veno-occlusive disease intake of 0.015mg / kg, which is equivalent to 70kg body weight 1mg daily adult . The main clinical manifestations of hepatic venular occlusive disease are refractory ascites, jaundice and hepatomegaly. There is no effective treatment of hepatic venular occlusive disease, mainly symptomatic and supportive treatment. In recent years, there are reports of glucocorticoid or heparin treatment, but efficacy and safety yet to be studied. The author believes that our country should strengthen education and monitoring of poisoning caused by PAs plants.