[논문]양약으로 유발된 약인성 간손상 환자 임상보고

손창규

양약으로 유발된 약인성 간손상 환자 임상보고
A Drug-Induced Liver Injury by Western Medication 원문보기

대한한방내과학회지 = The journal of internal Korean medicine, v.36 no.1, 2015년, pp.69 - 75

초록
AI-Helper

본 증례보고는 퇴행성 관절염으로 양방병원에서 치료를 받던 중에 발생한 약인성 간손상으로 한방병원에서 진단 및 치료 받은 73세의 여성 환자의 증례를 소개하고자 한다. 환자는 약 3개월 동안 양방병원에서 비스테로이드성 소염제와 근육이완제 등을 처방 받아 오던 중 점차적으로 피로감과 오심 구역감 등의 위장장애를 호소하였다. 양방 의원에서 수 차례 약물치료를 하였으나 호전되지 않고 점차 극심한 피로감과 무기력감 및 위장증상으로 한방병원을 찾게 되었다. 한방병원에서 혈액검사상에 급성감염(AST 90 IU/L, ALT 100 IU/L, ALP 191 IU/L, GGT 614 IU/L) 소견을 보였다. 초음파 검사상 정상적 소견과 다른 기저질환의 배제 및 RUCAM score가 9로서 약인성 간손상으로 진단이 되었다. 15일간의 뜸치료와 침치료 및 한약물 (청간플러스시럽)의 복용으로 주관적 증상은 완전히 소실되었으며 GGT를 제외한 간기능 검사도 정상으로 회복되었다. 그동안 한약물과 관련된 약인성 간손상에 대한 연구가 주로 양의학계에서 이루어지다보니 한약물의 안전성에 대한 부정적 평가가 많았었다. 그러한 의미에서 본 증례보고는 양약에 의한 약인성 간손상에 대한 전형적인 증상의 특성을 보여주고 약인성 간손상에 대한 한의학적 관리 및 치료의 향후 연구에 대한 의미있는 증례를 제시한다고 하겠다.

Abstract ▼ AI-Helper

Objectives : To investigate the clinical features of drug-induced liver injury (DILI) and traditional Korean medicine (TKM) -based management. Methods : A female patient diagnosed with DILI caused by Western drugs had been treated with Oriental therapies, then the subjective clinical outcome and biochemical parameters were monitored. Results : A 73-year-old female had taken Western drugs (nonsteroidal anti-inflammatory and skeletal muscle relaxants) for about 3 months, and complained of severe abdominal discomfort and tiredness. Her RUCAM score was 9, which met the criteria for DILI (AST 90 IU/L, ALT 100 IU/L, ALP 191 IU/L, and GGT 614 IU/L). She was treated with herbal drugs, moxibustion, and acupuncture, and her symptoms completely resolved, with normalized hepatic enzymes within two weeks. Conclusions : This case report provides a clinical characteristic for a typical DILI caused by Western medicine, and shows an example of a TKM-based application.

주제어

AI 본문요약
AI-Helper

문제 정의

This study aims to report a woman case with DILI by western medicine, which was recovered by TKM-based treatments.

대상 데이터

A 73-year-old woman has been healthy except a degenerative arthritis in both knees. She was standard body mass index (BMI, 22) with slight abdomen obesity.

이론/모형

It is difficult to confirm the DILI because no specific biomarkers or ‘gold standard’ diagnostic tests for DILI exists16. Roussel Uclaf Causality Assessment Method (RUCAM) is commonly used as a causality assessment algorithm to measure the strength of association between suspected DILI and an implicated agent17.

성능/효과

The principle of management for DILI is to stop early the suspected agents. The patient of this case had recovered quickly the both subjective symptoms and objective biomarkers from laboratory tests within 15 days. The majority of patients with symptomatic acute DILI are expected to completely recover with supportive care, and then 5% to 15% of patients had chronic DILI and persistent laboratory abnormalities24,25.
1% of 1,418 ADEs was caused by herbal medication in two spontaneously reported studies in Korea27,28. These conflict data resulted from the differences of study subjects, likely hospitalized patients with DILI versus total population with ADE or hepatic ADE. Some studies seem to exaggerate the possibility of herbal medicine-associated hepatotoxicity, which frequently leaded to distortion of reputation for herbal medicine in Korea29.
This case report presented a typical patient with a western drug-induced DILI, which had been improved by TKM therapy. This study would be helpful to provide the practical knowledge of DILI and information to care the patient with DILI in TKM field.

후속연구

This case report presented a typical patient with a western drug-induced DILI, which had been improved by TKM therapy. This study would be helpful to provide the practical knowledge of DILI and information to care the patient with DILI in TKM field.

참고문헌 (29)

Pandit A, Sachdeva T, Bafna P. Drug-Induced Hepatotoxicity: A Review. J Appl Pharma. Science 2012;2(5):233-43.
Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002;137(12):947-54.

상세보기
Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med. 2006;354:731-9.

상세보기
Ghabril M, Chalasani N, Björnsson E. Drug-induced liver injury: a clinical update. Curr Opin Gastroenterol 2010;26(3):222-6.

상세보기
Teschke R, Wolff A, Frenzel C, Schulze J. Review article: Herbal hepatotoxicity-an update on traditional Chinese medicine preparations. Aliment Pharmacol Ther 2014;40(1):32-50.

상세보기
Suk KT, Kim DJ, Kim CH, Park SH, Yoon JH, Kim YS, et al. A prospective nationwide study of drug-induced liver injury in Korea. Am J Gastroenterol 2012;107(9):1380-7.

상세보기
Park HM, Jang IS, Lee SD. Hepatotoxic Events Associated with Herbal Medicinal Products, Folk Remedies and Food Supplements in Korea. J Korean Oriental Med 2005;26(2):152-65.
Seo JC, Jeon WJ, Park SS, Kim SH, Lee KM, Chae HB, et al. Clinical experience of 48 acute toxic hepatitis patients. Korean J Hepatol 2006; 12(1):74-81.
Chun WJ, Yoon BG, Kim NI, Lee G, Yang CH, Lee CW, et al. A clinical study of patients with acute liver injury caused by herbal medication in Gyeongju area. Korean J Med 2002;63(2):141-50.
Available from URL: Drug com. http://www.drugs.com/sfx/meloxicam-side-effects.html
Available from URL: http://www.drugs.com/sfx/dantrium-side-effects.html
Available from URL: http://www.drugs.com/sfx/streptase-side-effects.html
Available from URL: ttp://www.mfds.go.kr/index.do?x0&searchkeytitle:contents&mid1029&searchword스티렌&cd167&y0&pageNo1&seq5604&cmdv
Farcas A, Bojita M. Adverse drug reactions in clinical practice: a causality assessment of a case of drug-induced pancreatitis. J Gastrointestin Liver Dis 2009;18(3):353-8.
Au JS, Navarro VJ, Rossi S. Review article: Drug-induced liver injury its pathophysiology and evolving diagnostic tools. Aliment Pharmacol Ther 2011;34(1):11-20.

상세보기
Arundel C, Lewis JH. Drug-induced liver disease in 2006. Curr Opin Gastroenterol 2007;23(3):244-54.

상세보기
Rochon J, Protiva P, Seeff LB, Fontana RJ, Liangpunsakul S, Watkins PB, et al. Reliability of the Roussel Uclaf Causality Assessment Method for assessing causality in drug-induced liver injury. Hepatology 2008;48(4):1175-83.

상세보기
Lucena MI, García-Cortés M, Cueto R, Lopez- Duran J, Andrade RJ. Assessment of drug-induced liver injury in clinical practice. Fundam Clin Pharmacol 2008;22(2):141-58.

상세보기
Madariaga MG. Drug-related hepatotoxicity. N Engl J Med 2006;354(20):2191-3.

상세보기
Bussières JF, Habra M. Application of International Consensus Meeting Criteria for classifying drug-induced liver disorders. Ann Pharmacother 1995;29(9):875-8.

상세보기
Sapey T, Mendler MH, Guyader D, Morio O, Corbinais S, Deugnier Y, et al. Respective value of alkaline phosphatase, gamma-glutamyl transpeptidase and 5' nucleotidase serum activity in the diagnosis of cholestasis: a prospective study of 80 patients. J Clin Gastroenterol 2000;30(3):259-63.

상세보기
Gierer IM, Abdala O, Calderón C, Risoli E, Cravero A, Pinchuk L. Meloxican-induced cholestasis. Acta Gastroenterol Latinoam 2000;30(5):511-4.
Manov I, Motanis H, Frumin I, Iancu TC. “Hepatotoxicity of anti-inflammatory and analgesic drugs: ultrastructural aspects”. Acta Pharmacol Sin 2006;27(3):259-72.

상세보기
Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008; 135(6):1924-34.

상세보기
Andrade RJ, Lucena MI, Kaplowitz N, García- Muņoz B, Borraz Y, Pachkoria K, et al. Outcome of acute idiosyncratic drug-induced liver injury: Long-term follow-up in a hepatotoxicity registry. Hepatology 2006;44(6):1581-8.

상세보기
Suk KT, Kim DJ. Drug-induced liver injury: present and future. Clinical and Mol. Hepat 2012;18(10):249-57.

상세보기
Shin YS, Lee YW, Choi YH, Park B, Jee YK, Choi SK, et al. Spontaneous reporting of adverse drug events by Korean regional pharmacovigilance centers. Pharmacoepidemiol Drug Saf 2009;18(10) :910-5.

상세보기
Kwon H, Lee SH, Kim SE, Lee JH, Jee YK, Kang HR, Park BJ, Park JW, Hong CS. Spontaneously reported hepatic adverse drug events in Korea: multicenter study. J Korean Med Sci 2012 Mar;27(3):268-73.

상세보기
Park HM, Jang IS, Lee SD. Hepatotoxic Events Associated with Herbal Medicinal Products, Folk Remedies and Food Supplements in Korea. J Korean Oriental Med 2005;26(2):152-65.

저자의 다른 논문 :

표제어: PCR

동의어: Packet Collision Rate

용어 설명 출처 목록 (6)

용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

내보내기 구분	파일저장 인쇄 메일전송
구성항목	기본정보 상세정보 관리번호, 논문명, 저널/프로시딩명, 저자 , 발행년, 권, 호, 시작페이지, 끝페이지, 발행기관 관리번호, 논문명, 대등논문명, 저자 , 저널/프로시딩명, 발행기관, 발행년, 발행언어, 권, 호, 시작페이지, 끝페이지, ISBN, ISSN, 주제분야, 키워드, 초록(한글), 초록(영문), 저자(소속기관)
저장형식	Text(ASCII format) Excel format RefWorks Direct Export RIS format (for Reference Manager, ProCite, EndNote), Scholar's Aids, Mendeley
메일정보	받는사람 (필수) @ 보내는사람 (선택) @ 제목 내용 KISTI 검색결과 이메일 서비스
안내	총 건의 자료가 검색되었습니다. 다운받으실 자료의 인덱스를 입력하세요. (1-10,000) 검색결과의 순서대로 최대 10,000건 까지 다운로드가 가능합니다. 데이타가 많을 경우 속도가 느려질 수 있습니다.(최대 2~3분 소요) 다운로드 파일은 UTF-8 형태로 저장됩니다. 파일의 내용이 제대로 보이지 않을실 때는 웹브라우저 상단의 보기 -> 인코딩 -> 자동선택 여부를 확인하십시오. ~ Text(ASCII format) Excel format

연합인증