Division of Gastroenterology, Department of Clinical Medicine, University of Rome 'Sapienza', Rome, Italy.
Clin Drug Investig. 2010;30(3):205-9. doi: 10.2165/11531660-000000000-00000.
We report a case of acute-onset, long-lasting cholestasis induced by atorvastatin. This antihyperlipidaemic drug was taken for 40 days by a 72-year-old male as a treatment for his mixed dyslipidaemia. At that point, the patient presented with asthenia, nausea, painless icterus, acholic stools and hyperchromic urine with biochemical analyses showing a dramatic increase in bilirubin (total bilirubin 22 mg/dL; direct bilirubin 21 mg/dL) and alkaline phosphatase (up to 4-fold over the normal level) with less marked increases in transaminases. Liver histology showed a pattern of cholestasis with evident signs of cholangiolitis and damage of the interlobular bile ducts. Serum transaminase and bilirubin levels returned to normal within 5 months after atorvastatin withdrawal while alkaline phosphatase normalized after only 8 months. Scores on both the Maria and Victorino clinical scale for the diagnosis of drug-induced hepatitis and the Naranjo Adverse Drug Reaction Probability Scale indicated that atorvastatin was the probable cause of prolonged cholestasis in this patient. This is a rare case of cholestasis probably caused by atorvastatin and unusually characterized by bile duct damage.
我们报告了一例由阿托伐他汀引起的急性发作、长期持续性胆汁淤积症。该降脂药物用于治疗一名 72 岁男性的混合性血脂异常，共服用了 40 天。当时，患者出现乏力、恶心、无痛性黄疸、白陶土样便和深茶色尿，生化分析显示胆红素（总胆红素 22mg/dL；直接胆红素 21mg/dL）显著升高，碱性磷酸酶（比正常值高 4 倍）升高，转氨酶升高不明显。肝组织学显示为胆汁淤积模式，伴有明显的胆小管炎和小叶间胆管损伤。阿托伐他汀停药后 5 个月内血清转氨酶和胆红素水平恢复正常，而碱性磷酸酶仅在 8 个月后恢复正常。Maria 和 Victorino 临床量表用于诊断药物性肝炎和 Naranjo 药物不良反应概率量表的评分均表明，阿托伐他汀是导致该患者长期胆汁淤积的可能原因。这是一例罕见的可能由阿托伐他汀引起的胆汁淤积症病例，其特征为胆管损伤。
