Department of Internal Medicine, University of Modena and Reggio Emilia, Policlinico di Modena-Medicina I, via Del Pozzo 71, Modena, Italy.
Intern Emerg Med. 2010 Jun;5(3):193-200. doi: 10.1007/s11739-009-0342-4. Epub 2010 Jan 27.
Despite its rarity, infliximab-related hepatitis constitutes a cutting edge and challenging problem. In December 2004, a drug warning was issued by the Food and Drug Administration to alert healthcare professionals to the risk of hepatotoxicity in course of infliximab therapy. Subsequently, several reports of probable infliximab hepatitis have been published and interest is growing in trying to elucidate the impact of these events on clinical practice. After discussing our case report, the main characteristics of infliximab-mediated liver injury are analyzed, coupled with a review of the medical literature. Infliximab seems to provoke both immunomediated and a direct liver injury, but how this latter happens remains unclear. Moreover, infliximab immunomediated liver dysfunction resembles that of autoimmune hepatitis type I, with elevation of antinuclear, anti-smooth muscle, anti-double-strand DNA antibodies, and a clear preference for female sex. Finally, a flow chart is proposed with the purpose to help clinicians in the management of patients who develop signs of liver dysfunction during treatment with infliximab.
尽管 infliximab 相关性肝炎较为罕见，但却是一个前沿且具有挑战性的问题。2004 年 12 月，美国食品和药物管理局发布了一则药物警告，提醒医疗保健专业人员注意 infliximab 治疗过程中肝毒性的风险。随后，发表了几篇可能与 infliximab 肝炎相关的报告，人们越来越关注这些事件对临床实践的影响。在讨论我们的病例报告后，分析了 infliximab 介导的肝损伤的主要特征，并结合文献复习。infliximab 似乎既引起免疫介导的肝损伤，也引起直接肝损伤，但后者的发生机制尚不清楚。此外，infliximab 免疫介导的肝功能障碍类似于自身免疫性肝炎 1 型，表现为抗核抗体、抗平滑肌抗体、抗双链 DNA 抗体升高，且女性更易受累。最后，提出了一个流程图，旨在帮助临床医生管理在使用 infliximab 治疗期间出现肝功能障碍的患者。
