Sura M E, Heinrich K A, Suseno M
Evanston Northwestern Healthcare-Evanston Hospital, IL 60201, USA.
Ann Pharmacother. 2000 Oct;34(10):1152-5. doi: 10.1345/aph.10021.
To report a case of acute reversible pancreatitis associated with metronidazole-treated aspiration pneumonia.
A 61-year-old white woman requiring coronary artery bypass surgery developed acute pancreatitis following treatment with metronidazole for suspected postsurgical aspiration pneumonia. The patient developed moderate to severe bilateral upper quadrant abdominal pain; laboratory studies revealed elevated amylase and lipase concentrations four days following the initiation of metronidazole therapy. After discontinuation of metronidazole, the patient's abdominal pain subsequently improved, and both amylase and lipase concentrations immediately declined and were within normal limits within one week.
An acute attack of pancreatitis is characterized by moderate to severe abdominal pain that may radiate to the back, accompanied by increased concentrations of pancreatic enzymes and few morphologic changes in the pancreas. Metronidazole is reported as having a probable association with acute pancreatitis, although the mechanism of drug-induced pancreatitis is not known. One speculative mechanism of metronidazole-induced pancreatitis is that, under aerobic conditions, metronidazole may undergo redox cycling and yield hydrogen peroxide, superoxide, and other free radicals. Such redox-active compounds are toxic to pancreatic beta-cells, and oxygen-centered free radicals have been implicated in the induction of pancreatitis. Other suggested mechanisms include immune-mediated inflammatory response, pancreatic duct constriction, and metabolic effects.
Very few cases of metronidazole-associated pancreatitis have been reported, and the long-term sequelae are unknown. However, if metronidazole or any other drug is suspected as the causative agent in pancreatitis, it should be discontinued and rechallenge should be avoided.
报告一例与甲硝唑治疗的吸入性肺炎相关的急性可逆性胰腺炎病例。
一名61岁白人女性，因疑似术后吸入性肺炎接受甲硝唑治疗后，在需要进行冠状动脉搭桥手术时发生了急性胰腺炎。患者出现中度至重度双侧上腹部疼痛；实验室检查显示，甲硝唑治疗开始四天后淀粉酶和脂肪酶浓度升高。停用甲硝唑后，患者的腹痛随后有所改善，淀粉酶和脂肪酶浓度立即下降，并在一周内恢复至正常范围。
胰腺炎急性发作的特征是中度至重度腹痛，疼痛可能会放射至背部，同时伴有胰腺酶浓度升高，而胰腺形态学变化较少。据报道，甲硝唑可能与急性胰腺炎有关，尽管药物性胰腺炎的机制尚不清楚。甲硝唑诱发胰腺炎的一种推测机制是，在有氧条件下，甲硝唑可能会发生氧化还原循环，产生过氧化氢、超氧化物和其他自由基。这类具有氧化还原活性的化合物对胰腺β细胞有毒性，以氧为中心的自由基被认为与胰腺炎的诱发有关。其他提出的机制包括免疫介导的炎症反应、胰管狭窄和代谢作用。
甲硝唑相关性胰腺炎的报道病例极少，其长期后遗症尚不清楚。然而，如果怀疑甲硝唑或任何其他药物是胰腺炎的致病因素，应停药并避免再次使用。
