Lange-Brock N, Berg T, Müller A R, Fliege H, Neuhaus P, Wiedenmann B, Klapp B F, Mönnikes H
Medizinische Klinik mit Schwerpunkt Psychosomatik und Psychotherapie des Universitätsklinikum Charité der Humboldt-Universität zu Berlin, Germany.
Z Gastroenterol. 2002 Aug;40(8):581-6. doi: 10.1055/s-2002-33416.
The use of "ecstasy" (Methylenedioxymethamphetamine) as a recreational drug is increasing in europe since the 1980's. Aside intended psychological effects the use of ecstasy can be followed by symptoms of intoxication; complications include toxic hepatic damage up to acute hepatic failure. This case-report is about a 17-year old female patient who regularly used "ecstasy" over a six-month period. Two days after the last use of "ecstasy", she reported to her general practitioner with nausea, vomiting, abdominal pain and jaundice. Within 10 days the patient developed acute liver failure. With criteria for liver transplantation fulfilled she was listed for orthotopic liver transplantation of high urgency which was carried out only one day later. Histological examination of the explanted liver showed evidence for a toxic fulminant hepatitis. After transplantation the patient made a full recovery and was released from hospital on day 26 after transplantation. At the first control after six months the patient was in good physical and nutritional condition, serological parameters were normal and ultrasound examination of the transplanted liver was unremarkable. The ethiopathology of "ecstasy"-induced hepatotoxicity, which can occur dose-independently with a symptom-free period from days to weeks after ingestion is not yet fully understood. Possible mechanisms of hepatic damage include influence of MDMA on body temperature regulation, harmful effects of the substance or further components of the "ecstasy"-tablets on the liver cell or a genetic vulnerability of some individuals against amphetamines and amphetamine derivates. There are no parameters existing which could predict the course and severity of "ecstasy"-induced hepatopathy. Especially in young patients with symptoms of hepatic damage frequent controls of clinical status and relevant laboratory parameters are of great importance. Patient transfer to a specialised centre should follow as early as possible; at the latest, when coagulopathy occurs.
自20世纪80年代以来，“摇头丸”（亚甲二氧基甲基苯丙胺）作为一种消遣性毒品在欧洲的使用呈上升趋势。除了预期的心理影响外，使用摇头丸后可能会出现中毒症状；并发症包括毒性肝损伤直至急性肝衰竭。本病例报告讲述的是一名17岁女性患者，她在六个月内经常使用“摇头丸”。在最后一次使用“摇头丸”两天后，她因恶心、呕吐、腹痛和黄疸向她的全科医生就诊。在10天内，患者发展为急性肝衰竭。由于符合肝移植标准，她被列入紧急原位肝移植名单，仅一天后就进行了移植手术。对切除肝脏的组织学检查显示有中毒性暴发性肝炎的证据。移植后患者完全康复，并在移植后第26天出院。在六个月后的首次复查中，患者身体和营养状况良好，血清学参数正常，移植肝脏的超声检查无异常。“摇头丸”所致肝毒性的发病机制尚未完全明了，其可在摄入后数天至数周的无症状期内不依赖剂量发生。肝损伤的可能机制包括摇头丸对体温调节的影响、该物质或“摇头丸”片剂的其他成分对肝细胞的有害作用，或某些个体对苯丙胺及其衍生物的遗传易感性。目前尚无参数可预测“摇头丸”所致肝病的病程和严重程度。特别是对于有肝损伤症状的年轻患者，频繁监测临床状况和相关实验室参数非常重要。应尽早将患者转至专科中心；最迟在出现凝血病时进行。
