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Toksični učinek na jetra - kitajska zeliščna medicina ga pri rakavih bolnikih ne povzroča

Updated: Feb 14

Ko pride do integrativne medicine (kombiniranje tako kitajske kot tudi splošne medicine), je ena izmed najobičajnejših ovir možnost pojava toksičnega učinka na jetra, ki bi jih lahko povzročila zdravila kitajske medicine.


Na svetu je le malo krajev kot je Hong Kong, kjer v javnem zdravstvenem sistemu prevladujeta sodobna in zahodna medicina, medtem ko je v družbi široko rabljena in globoko zakoreninjena TKM.


Takšna situacija iz Hong Konga je bolj primerljiva situaciji na Zahodu, medtem ko ostale države, kot so Koreja ali Kitajska, svojo medicino uradno vključujejo v formalni sistem zdravstvene oskrbe. Zato se klinična praksa precej razlikuje od te na Zahodu. Dr. So Tscz Him z oddelka za klinično onkologijo iz bolnišnice Queen Mary Hospital v Hong Kongu je objavil pomembno raziskavo trenutne rabe TKM in zdravil za boj proti raku pri zdravljenju raka. Za onkologe in paciente je toksični učinek na jetra vedno med glavnimi skrbmi.


Zato so pridobljeni rezultati brezdvomno vredna referenca.


Pilotna presečna raziskava pojavnosti toksičnega učinka na jetra pri pacientih z rakavim obolenjem, ki so na kemoterapiji zahodne medicine z ali brez sočasne rabe kitajske zeliščne medicine

Povzetek

Ozadje

Tako splošna kot kitajska medicina sta v Hong Kongu dobro sprejeti, ne glede na različne metode in sistematike. Glede na anketo, ki jo je izvedla hongkonška baptistična univerza v l. 2009 s pacienti rakavih obolenj, se je 57% pacientov posluževalo vsaj ene oblike zdravljenja kitajske medicine. Med temi, ki so bili na kemoterapiji, je bilo 60% le-teh sočasno deležnih zeliščne terapije tradicionalne kitajske medicine (TKM).


Ta pilotna študija je naslavljala problem hepatotoksičnosti sočasne rabe zeliščne terapije tradicionalne kitajske medicine (TKM), ki je glavna ovira integrativne oblike kitajsko-zahodne prakse pri medicini raka. Ocenjevali so razliko v pojavnosti toksičnega učinka na jetra pri pacientih z rakavimi obolenji, ki so bili na sistematični terapiji z ali brez sočasne TKM zeliščne terapije.


Metode

Na oddelku za klinično onkologijo bolnišnice Queen Mary Hospital so morebitno pridobili 187 pacientov. Skozi vprašalnike in spletnega kliničnega sistema menedžmenta (CMS) so jih spremljali tri mesece, kjer so pridobivali rezultate njihovih terapij po zahodni sistemični medicini, TKM zeliščne terapije in testov funkcionalnosti jeter (bilirubin, ALT, AST, ALP). Paciente so razdelili v skupino s TKM zeliščno terapijo in skupino brez TKM zeliščne terapije, in sicer z upoštevanjem parametra, ali so bili deležni TKM zeliščne terapije sočasno z sistemično terapijo. Premike v funkcioniranju jeter so ocenili po CTCAE v4.0. Razlike med skupinama so analizirali s pomočjo hi-kvadratnega testa in Mann-Whitneyevega U-testa. Analizo z večimi spremenljivkami so izvedli s Coxovim modelom sorazmernih tveganj z namenom identifikacije prognostičnih dejavnikov za kritje TKM zeliščne terapije.


Rezultati

Med skupinama se ni pojavila bistvena razlika glede pojavnosti toksičnega učinka na jetra (P=0,577). Za kritje TKM zeliščne terapije ni bilo identificiranih nobenih prognostičnih

faktorjev (starost in spol).

Zaključki

Rezultati pilotne raziskave sugerirajo, da sočasna raba TKM zeliščne terapije pri pacientih z rakavimi obolenji ne zvišuje tveganja za pojav toksičnega učinka na jetra. Ti rezultati nadalje jamčijo za raziskave v bodoče, ki bi potrdile to odkritje. vir: https://doi.org/10.1093/annonc/mdz434.021

prevod: Tanja Topić

vir fotografij: internet

Chinese herbal medicine is safe from liver toxicity in cancer patients


One of the most common obstacles when it comes to integrative medicine (a combination of both Chinese and conventional medicine) is the possibility of liver toxicity caused by Chinese herbal medicines. There are very few places in the world like Hong Kong where modern and Western medicine is dominating in the public health care system while TCM is widely practiced and deep-rooted in the society. This situation in Hong Kong is more comparable to the West while other Asian countries like Korea or China officially integrate their traditional medicine into the formal healthcare system so the clinical practice is more different to the West. Dr. So Tsz Him from the clinical oncology department, Queen Mary Hospital, Hong Kong, published an important piece of study on the current use of TCM and anticancer drugs in cancer care. Liver toxicity is always the top concern for patients and oncologists.


This result is undoubtedly a valuable reference.


A pilot cross-sectional study on the incidence of liver toxicity in cancer patients on western anti-cancer drug therapy with or without concurrent Chinese herbal medicine

Abstract

Background

Both Western and Chinese medicine, despite the differences in methods and systems, are well accepted in Hong Kong. According to a survey on cancer patients in Hong Kong conducted by the Hong Kong Baptist University in 2009, 57% of cancer patients used at least one form of Chinese Medicine therapy. Among those who were on chemotherapy, 60% of them are concurrently receiving Traditional Chinese Medicine (TCM) herbal therapy.


This pilot study addressed the problem of hepatotoxicity of concurrent Traditional Chinese Medicine (TCM) herbal therapy use, which is the major hurdle of integrated Chinese-Western medicine practice in cancer medicine. We evaluated the difference in the incidence of liver toxicity of cancer patients receiving systemic therapy with or without concurrent TCM herbal therapy.


Methods

187 patients were prospectively recruited in the Department of Clinical Oncology of Queen Mary Hospital. Through questionnaires and the online Clinical Management System (CMS), they were followed up for 3 months, their current Western systemic therapy, TCM herbal therapy taken, and liver function tests results (bilirubin, ALT, AST, ALP) were retrieved. Patients were divided into the TCM herbal therapy and non-TCM herbal therapy group, depending on whether TCM herbal therapy was taken concurrently with systemic therapy. Liver function derangement was graded by CTCAE v4.0. The differences between the TCM herbal therapy and non-TCM herbal therapy groups were analysed by Pearson’s chi-square test and Mann-Whitney U tests. Multivariable analysis was performed by Cox proportional hazard models to identify the prognostic factors for TCM herbal therapy coverage.


Results

There was no significant difference in liver toxicity incidence between the TCM herbal therapy and non-TCM herbal therapy group(P = 0.577). No prognostic factors (age and sex) were identified for TCM herbal therapy coverage.

Conclusions

The results of our pilot study suggest that concurrent TCM herbal therapy usage by cancer patients does not increase the risk of liver toxicity. Our results warrant further prospective studies to confirm the finding. SOURCE (DOI):https://doi.org/10.1093/annonc/mdz434.021

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