In Taiwan, the remarkably high incidence of UUC (13), coupled with widespread use of Aristolochia herbal remedies, suggested that AA might play a central role in the etiology of this disease. The high level of exposure to AA in Taiwan has been documented by a systematic analysis of prescriptions filled by a 200,000 person random sample of the entire insured population of Taiwan between 1997 and 2003, revealing that approximately one-third of these individuals consumed herbs containing, or likely to contain, AA (14). Moreover, consumption of AA is associated, in a dose-dependent manner, with an increased risk of developing end-stage renal disease or urothelial carcinoma (13, 15). Importantly, 43% of these carcinomas were located in the upper urinary tract (13).

结论

In conclusion, this study provides compelling evidence for the primary role of AA in the etiology of UUC in Taiwan. Importantly, the traditional practice of Chinese herbal medicine in Taiwan mirrors that in China and other Asian countries. Thus, it appears likely that UUC and its attendant AAN also are prevalent in these and in other countries where Aristolochia herbs have long been used for treatment and prevention of disease (1, 5). Because of the lifelong persistence of mutagenic DNA-AL-I adducts in target tissues and irreversible damage to the proximal renal tubules caused by AA, persons treated with Aristolochia herbal preparations at any time in their life are at significant risk of developing UUC or chronic renal disease, thereby creating an international public health problem of considerable magnitude.