Scott D A, Gholson C F, Netchvolodoff C V, Ray M, Gonzalez E, Bacon B R
Department of Medicine, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana.
Am J Gastroenterol. 1991 Apr;86(4):500-2.
Valproic acid has been implicated in at least 100 cases of fatal acute liver failure. Most cases have occurred in patients less than 10 yr old; however, at least seven have involved adults. Microvesicular steatosis has been uniformly observed, but its incidence in less severe liver disease and in asymptomatic patients receiving valproate is unknown. We report two patients receiving maintenance valproate, one with resolving acute hepatitis C and the other with chronic persistent hepatitis C, with incidental microvesicular steatosis demonstrated on oil-red O stains. We conclude that microvesicular steatosis does not necessarily signify hepatotoxicity in patients on chronic valproic acid, and should not lead to discontinuation of the drug until other causes of acute or chronic liver disease have been excluded.
丙戊酸已涉及至少100例致命性急性肝衰竭病例。大多数病例发生在10岁以下的患者中；然而，至少有7例涉及成人。均观察到微泡性脂肪变性，但其在病情较轻的肝病患者以及接受丙戊酸盐治疗的无症状患者中的发生率尚不清楚。我们报告了两名接受丙戊酸维持治疗的患者，一名患有急性丙型肝炎正在康复，另一名患有慢性持续性丙型肝炎，油红O染色显示有偶然的微泡性脂肪变性。我们得出结论，微泡性脂肪变性在慢性丙戊酸治疗的患者中不一定意味着肝毒性，在排除急性或慢性肝病的其他病因之前，不应导致停药。
