Liver injury from herbal and dietary supplements.
Liver injury from herbal and dietary supplements.
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DOI：
10.1002/hep.28813
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发表时间：
2017-01
期刊：
影响因子：
--
通讯作者：
Hoofnagle JH
中科院分区：
文献类型：
--
作者：
Navarro VJ;Khan I;Björnsson E;Seeff LB;Serrano J;Hoofnagle JH
草药和膳食补充剂(HDS)在美国和世界范围内的使用越来越多，HDS在美国引起的肝损伤也在按比例增加。由美国肝病研究协会和美国国立卫生研究院主办的为期两天的研究研讨会的焦点是目前HDS引起的肝损伤的诊断和治疗方面的挑战。根据研究数据，HDS引起的肝损伤现在占美国肝毒性病例的20%。主要的影响因素包括合成类固醇、绿茶提取物和多成分营养补充剂(MIN)。作为健美补充剂销售的合成类固醇通常会导致长期的胆汁淤积，但最终会导致自限性肝损伤，具有独特的血清生化和组织学表型。相比之下，绿茶提取物和许多其他产品往往会导致急性肝炎样损伤。然而，目前大多数HDS相关性肝损伤的病例都是由MINS引起的，导致这种毒性的成分通常是未知的或只能被怀疑。HDS所致的肝损伤在诊断、责任成分的识别、治疗和预防方面面临着许多临床和研究挑战。同样重要的是改善对非处方药的监管，以保证其成分并确保纯度和安全性。要确定HDS中的有害成分，需要临床医生、化学家和毒理学家之间的战略协调。最终目标应该是禁止或更严格地监管潜在的有害成分，从而促进公共安全。
Herbal and dietary supplements (HDS) are used increasingly both in the United States and worldwide and HDS induced liver injury in the U.S. has increased proportionally. Current challenges in the diagnosis and management of HDS-induced liver injury were the focus of a 2-day research symposium sponsored by the American Association for the Study of Liver Disease and the National Institutes of Health. HDS-induced liver injury now accounts for 20% of cases of hepatotoxicity in the United States based on research data. The major implicated agents include anabolic steroids, green tea extract, and multi-ingredient nutritional supplements (MINS). Anabolic steroids marketed as bodybuilding supplements typically induce a prolonged cholestatic, but ultimately self-limiting liver injury that has a distinctive serum biochemical as well as histological phenotype. Green tea extract and many other products, in contrast, tend to cause an acute-hepatitis like injury. Currently, however, the majority of cases of HDS-associated liver injury are due to MINS, and the component responsible for the toxicity is usually unknown or can only be suspected. HDS-induced liver injury presents many clinical and research challenges, in diagnosis, identification of the responsible constituents, treatment and prevention. Also important are improvements in regulatory oversight of non-prescription products to guarantee their constituents and insure purity and safety. The confident identification of injurious ingredients within HDS will require strategic alignments among clinicians, chemists, and toxicologists. The ultimate goal should be to prohibit or more closely regulate potentially injurious ingredients and thus promote public safety.
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影响因子：
4.2
作者：
Bailey, Regan L.;Gahche, Jaime J.;Picciano, Mary Frances
通讯作者：
Picciano, Mary Frances
影响因子：
6.3
作者：
Hsu, Chung-Hua;Tsai, Tung-Hu;Chou, Pesus
通讯作者：
Chou, Pesus
DOI：
10.3945/jn.111.142257
发表时间：
2011-10
期刊：
The Journal of nutrition
影响因子：
--
作者：
Fulgoni VL 3rd;Keast DR;Bailey RL;Dwyer J
通讯作者：
Dwyer J
影响因子：
29.4
作者：
Andrade, RJ;Lucena, MI;Martin-Vivaldi, R
通讯作者：
Martin-Vivaldi, R
影响因子：
6.7
作者：
El Sherrif, Yasser;Potts, Jonathan R.;Verma, Sumita
通讯作者：
Verma, Sumita