Herbal hepatotoxicity:Challenges and pitfalls of causality assessment methods

作     者：Rolf Teschke Christian Frenzel Johannes Schulze Axel Eickhoff 

作者机构：Division of Gastroenterology and HepatologyDepartment of Internal Medicine ⅡKlinikum HanauD-63450 HanauGermany Academic Teaching Hospital of the Medical FacultyJohann Wolfgang Goethe-Universit t Frankfurt am MainD-60590 Frankfurt am MainGermany Department of Medicine ⅠUniversity Medical Center Hamburg EppendorfD-20246 HamburgGermany nstitute of IndustrialEnvironmental and Social MedicineMedical FacultyJohann Wolfgang GoetheUniversitat Frankfurt am MainD-60590 Frankfurt am MainGermany 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2013年第19卷第19期

页      面：2864-2882页

核心收录：

学科分类：1008[医学-中药学(可授医学、理学学位)] 1006[医学-中西医结合] 100602[医学-中西医结合临床] 10[医学] 

主　　题：Herbal hepatotoxicity Herb induced liver injury Herbs Drug hepatotoxicity Drug induced liver injury Causality assessment 

摘      要：The diagnosis of herbal hepatotoxicity or herb induced liver injury(HILI) represents a particular clinical and regulatory challenge with major pitfalls for the causality *** the day HILI is suspected in a patient,physicians should start assessing the quality of the used herbal product,optimizing the clinical data for completeness,and applying the Council for International Organizations of Medical Sciences(CIOMS) scale for initial causality *** scale is structured,quantitative,liver specific,and validated for hepatotoxicity *** items provide individual scores,which together yield causality levels of highly probable,probable,possible,unlikely,and *** completion by additional information including raw data,this scale with all items should be reported to regulatory agencies and manufacturers for further *** CIOMS scale is preferred as tool for assessing causality in hepatotoxicity cases,compared to numerous other causality assessment methods,which are inferior on various *** these disputed methods are the Maria and Victorino scale,an insufficiently qualified,shortened version of the CIOMS scale,as well as various liver unspecific methods such as thead hoc causality approach,the Naranjo scale,the World Health Organization(WHO) method,and the Karch and Lasagna *** expert panel is required for the Drug Induced Liver Injury Network method,the WHO method,and other approaches based on expert opinion,which provide retrospective analyses with a long delay and thereby prevent a timely assessment of the illness in question by the *** conclusion,HILI causality assessment is challenging and is best achieved by the liver specific CIOMS scale,avoiding pitfalls commonly observed with other approaches.