Teoh Narci C, Farrell Geoffrey C
Storr Liver Unit, Westmead Millennium Institute, University of Sydney at Westmead Hospital, Darcy Road, PO Box 412, Westmead, New South Wales 2145, Australia.
Clin Liver Dis. 2003 May;7(2):401-13. doi: 10.1016/s1089-3261(03)00022-9.
NSAIDs are one of most frequently prescribed agents in clinical practice. Whereas hepatotoxicity is a rare complication of most NSAIDs (typically 1 to 10 per 100,000 persons exposed), the high level of usage means that these drugs cause liver disease. Because of their divergent chemical structures, the mechanisms and clinicopathological manifestations of hepatotoxicity vary widely. The reactive metabolite syndrome, in which serious rash, eosinophilia, and other forms of tissue injury are common, may be incited by several NSAIDs, including newer agents. Women, people aged more than 50 years, and for some drugs, the type of arthritis, may be risk factors for drug-induced liver injury. The spectrum of NSAID-drug related hepatotoxicity continues to expand, with reports of interactive toxicity in adults with hepatitis C and recognition of rare cases of liver disease associated with non-selective, selective, and preferential COX-2 inhibitors. Better outcomes require people taking NSAIDs to be aware of possible drug reactions involving the liver, and prescribers should be vigilant for early symptoms of hepatotoxicity so that incriminated agents are discontinued promptly.
非甾体抗炎药（NSAIDs）是临床实践中最常处方的药物之一。虽然肝毒性是大多数非甾体抗炎药罕见的并发症（通常每10万名暴露者中有1至10例），但高使用量意味着这些药物会导致肝脏疾病。由于其化学结构不同，肝毒性的机制和临床病理表现差异很大。反应性代谢物综合征中常见严重皮疹、嗜酸性粒细胞增多和其他形式的组织损伤，可能由几种非甾体抗炎药引发，包括新型药物。女性、50岁以上人群以及某些药物中的关节炎类型，可能是药物性肝损伤的危险因素。非甾体抗炎药相关肝毒性的范围不断扩大，有关于丙型肝炎成人患者交互毒性的报道，以及与非选择性、选择性和优先COX - 2抑制剂相关的罕见肝病病例的认识。更好的结果需要服用非甾体抗炎药的人了解可能涉及肝脏的药物反应，开处方者应警惕肝毒性的早期症状，以便及时停用有问题的药物。
