Kneiseler G, Bachmann H S, Bechmann L P, Dechene A, Heyer T, Baba H, Saner F, Jochum C, Gerken G, Canbay A
Division of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany.
Case Rep Gastroenterol. 2010 Feb 6;4(1):57-65. doi: 10.1159/000262448.
The incidence of drug-induced acute liver failure is increasing. A number of drugs can inhibit mitochondrial functions, alter β-oxidation and cause accumulation of free fatty acids within the hepatocytes. This may result in hepatic steatosis, cell death and liver injury. In our case, propofol, an anesthetic drug commonly used in adults and children, is suspected to have induced disturbance of the mitochondrial respiratory chain, which in consequence led to insufficient energy supply and finally liver failure. We report the case of a 35-year-old Caucasian woman with acute liver failure after anesthesia for stripping of varicose veins. Liver histology, imaging and laboratory data indicate drug-induced acute liver failure, presumably due to propofol. Hepatocyte death and microvesicular fatty degeneration of 90% of the liver parenchyma were observed before treatment with steroids. Six months later, a second biopsy was performed, which revealed only minimal steatosis and minimal periportal hepatitis. We suggest that propofol led to impaired fatty acid oxidation possibly due to a genetic susceptibility. This caused free fatty acid accumulation within hepatocytes, which presented as hepatocellular fatty degeneration and cell death. Large scale hepatocyte death was followed by impaired liver function and, consecutively, progressed to acute liver failure.
药物性急性肝衰竭的发病率正在上升。许多药物可抑制线粒体功能，改变β-氧化并导致肝细胞内游离脂肪酸蓄积。这可能导致肝脂肪变性、细胞死亡和肝损伤。在我们的病例中，丙泊酚，一种常用于成人和儿童的麻醉药物，被怀疑诱发了线粒体呼吸链紊乱，进而导致能量供应不足，最终引发肝衰竭。我们报告一例35岁白种女性在接受静脉曲张剥脱术麻醉后发生急性肝衰竭的病例。肝脏组织学、影像学和实验室数据表明为药物性急性肝衰竭，推测是由丙泊酚所致。在使用类固醇治疗前，观察到肝细胞死亡以及90%的肝实质出现微泡性脂肪变性。6个月后进行了第二次活检，结果显示仅有轻微脂肪变性和轻微汇管区肝炎。我们认为丙泊酚可能由于遗传易感性导致脂肪酸氧化受损。这导致肝细胞内游离脂肪酸蓄积，表现为肝细胞脂肪变性和细胞死亡。大量肝细胞死亡继而导致肝功能受损，并进而发展为急性肝衰竭。
