Zhou Judith, Shaw Simon G, Gilleece Yvonne
The Lawson Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, UK.
Int J STD AIDS. 2013 Aug;24(8):667-9. doi: 10.1177/0956462413479894. Epub 2013 Jul 16.
We report here the first two cases of hepatobiliary pathology in HIV-positive men following recreational use of ketamine: >1 g/day over a 12-month period while on ritonavir-based antiretroviral therapy. Presentation in each case was acute with nausea, vomiting and epigastric pain. Alanine aminotransferase was raised at 3.2× and 10.1 × upper limit of normal and alkaline phosphatase was raised at 1.7× and 2.5 × ULN for cases 1 and 2, respectively. Magnetic resonance cholangiopancreatography showed dilatation of the common bile duct; case 1, 18 mm and case 2, 14 mm with no ductal obstruction on endoscopic retrograde cholangiopancreatography. The symptoms resolved, common bile duct dilatation and liver function improved on discontinuation of ketamine use. Time to development of symptoms is shorter than reported in HIV-negative cases (12 months vs. 4 years) which may be explained by an interaction between ketamine and ritonavir.
我们在此报告首例两例在娱乐性使用氯胺酮后出现肝胆病变的HIV阳性男性病例：在接受基于利托那韦的抗逆转录病毒治疗期间，12个月内每日使用量超过1克。两例病例均急性起病，伴有恶心、呕吐和上腹部疼痛。病例1和病例2的丙氨酸转氨酶分别升高至正常上限的3.2倍和10.1倍，碱性磷酸酶分别升高至正常上限的1.7倍和2.5倍。磁共振胰胆管造影显示胆总管扩张；病例1为18毫米，病例2为14毫米，内镜逆行胰胆管造影未发现导管阻塞。停用氯胺酮后，症状缓解，胆总管扩张和肝功能改善。症状出现的时间比HIV阴性病例报道的要短（12个月对4年），这可能是氯胺酮与利托那韦相互作用所致。
