Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh.
Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh.
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DOI：
10.1155/2009/918156
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发表时间：
2009
影响因子：
0.8
通讯作者：
Cotler SJ
中科院分区：
文献类型：
--
作者：
Guzman G;Kallwitz ER;Wojewoda C;Chennuri R;Berkes J;Layden TJ;Cotler SJ
有越来越多的病例详细说明急性肝坏死患者服用黑升麻（Cimicifuga racemosa），一种非处方草药补充管理更年期症状。我们的目的是说明两例肝损伤后使用黑升麻的特点是模仿自身免疫性肝炎的组织病理学特征。两名患者报告使用黑升麻至少6个月，没有证据表明其他原因的肝脏疾病。他们的肝脏活检显示小叶中心坏死的成分与严重的药物性肝损伤一致。此外，活检显示自身免疫性样肝损伤特征，以浆细胞为主的界面肝炎。虽然自身免疫性肝炎的血清标志物没有特别升高，但两名患者对皮质类固醇有反应，支持免疫介导的肝损伤成分。肝损伤后使用黑升麻应列入鉴别诊断的慢性肝炎与自身免疫性肝炎的特征。
There are a growing number of cases detailing acute hepatic necrosis in patients taking black cohosh (Cimicifuga racemosa), an over-the-counter herbal supplement for management of menopausal symptoms. Our aim is to illustrate two cases of liver injury following the use of black cohosh characterized by histopathological features mimicking autoimmune hepatitis. Both patients reported black cohosh use for at least six months and had no evidence of another cause of liver disease. Their liver biopsies showed a component of centrilobular necrosis consistent with severe drug-induced liver injury. In addition, the biopsies showed characteristics of autoimmune-like liver injury with an interface hepatitis dominated by plasma cells. Although serum markers for autoimmune hepatitis were not particularly elevated, both patients responded to corticosteroids, supporting an immune-mediated component to the liver injury. Liver injury following the use of black cohosh should be included in the list of differential diagnoses for chronic hepatitis with features mimicking autoimmune hepatitis.