首页|Herb induced liver injury by Xianling Gubao Tablets:A case assessed for causality using updated RUCAM and integrated evidence chain
Herb induced liver injury by Xianling Gubao Tablets:A case assessed for causality using updated RUCAM and integrated evidence chain
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Objective:A typical case of Xianling Gubao(XLGB)Tablets-induced liver injury was systematically stud-ied in the clinic and the laboratory.Methods:A patient with herb-induced liver injury(HILI)and a history of taking XLGB Tablets before dis-ease onset was engaged as the study subject,and the case was diagnosed according to the updated Roussel Uclaf Causality Assessment Method(RUCAM)and the integrated evidence chain(iEC)method recommended by the Guidelines for Diagnosis and Treatment of Herb-induced Liver Injury(HILI Guidelines).Results:Clinical history,biochemical indexes and imaging tests were used to exclude the influence of fundamental diseases and confusing liver diseases such as viral,alcoholic and autoimmune liver diseases on the diagnosis.Based on an investigation of the patient's medication history,she was suspected to have HILI caused by XLGB Tablets,as the patient was only taking an oral preparation of XLGB Tablets,and the influence of other drugs on the diagnosis was excluded.This patient with alanine aminotransferase(ALT)≥ 3 × upper limit of normal(ULN)and a calculated R of 6 was diagnosed with possible acute drug-induced hepatocellular injury.The relationship was considered"highly probable"(score of 9)using the updated RUCAM of 2016.Moreover,the fingerprint similarity between the preparation taken by the patient and a commercially available preparation was 0.99,suggesting that the patient was consuming XLGB Tablets rather than another drug.LC-MS technology and the Agilent Fake TCM-Drugs database were used to investigate the drug,and no chemical additions were found.Examination of the drug for pesticide residues,heavy metals,aflatoxins and other exogenous substances indicated compliance with the content limits of the Chinese Pharmacopoeia.Conclusion:In summary,the final diagnosis of XLGB-induced liver injury reached the clinical diagnosis of HILI and was acute severe hepatocellular injury type by the updated RUCAM and iEC.Therefore,this study provides scientific evidence regarding the causality evaluation of compound preparations of tradi-tional Chinese medicines-induced liver injury.
chemical analysiscompound preparations of traditionalchinese medicinesintegrated evidence chainliver injuryRoussel Uclaf Causality Assessment MethodXianling Gubao Tablets
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China
Senior Department of Hepatology,The Fifth Medical Center of PLA General Hospital,Beijing 100039,China
School of Traditional Chinese Medicine,Capital Medicinal University,Beijing 100069,China
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