Guneysel Ozlem, Onur Ozge Ecmel, Akoglu Haldun, Denizbasi Arzu
Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Turkey.
Curr Ther Res Clin Exp. 2008 Jun;69(3):260-5. doi: 10.1016/j.curtheres.2008.06.001.
The drug 3,4-methylenedioxymethamphetamine (MDMA), otherwise known as "ecstasy," is a synthetic amphetamine that produces euphoria, increases sociability and energy, and is often used as a "weekend" recreational drug by young adults.
A 23-year-old male (height, 184 cm; weight, 68 kg) presented to the emergency department of Marmara University Hospital, Istanbul, Turkey, with jaundice and nausea lasting for 6 days. The patient reported that he had been a chronic user of MDMA for 2 years. He also reported that 1 week before presenting, he had ingested twice (2 tablets) the usual amount (1 tablet) of the drug at the same time. Blood tests were performed and hematologic findings were as follows: aspartate aminotransferase (AST), 1423 U/L (reference range, 10-37 U/L); alanine aminotransferase (ALT), 2748 U/L (10-40 U/L); alkaline phosphatase, 271 U/L (0-270 U/L); γ-glutamyl transpeptidase, 124 U/L (7-49 U/L); total bilirubin, 13.23 mg/dL (0.2-1 mg/dL); direct bilirubin, 8.75 mg/dL (0-0.3 mg/dL); amylase, 80 U/L (0-220 U/L); prothrombin time, 21.2 sec; activated partial thromboplastin time, 37.3 sec; and international normalized ratio, 1.66. Liver enzymes and bilirubin levels were found to be extremely high (AST = 40x normal, ALT = 70x normal, and bilirubin = 13x normal). Viral, autoimmune, and metabolic causes were excluded. Serologic tests for hepatitis A, B, and C viruses, mononucleosis, cytomegalovirus, and HIV infection were all negative. A diagnosis of ecstasy-induced toxic hepatitis was made. The patient's medical history further revealed that the current incident was actually his second occurrence of jaundice and acute hepatitis associated with the ingestion of higher amounts (twice the usual amount of MDMA he ingested at the same time). Supportive therapy (IV saline and vital sign monitoring) was initiated and liver enzymes, bilirubin levels, and prothrombin times were monitored daily. All had returned to normal values in 2 weeks.
MDMA, or the recreational drug ecstasy, might be responsible for acute hepatitis and/or acute liver failure, particularly in young people. Physicians might need to be alert to the possibility of ecstasy-induced liver damage occurring in younger patients, although the presence of other hepatotoxins and alternative diagnoses requires exclusion. The use of this drug should be investigated in young patients with severe hepatitis of unknown origin.
药物3,4-亚甲基二氧甲基苯丙胺（MDMA），又称“摇头丸”，是一种合成苯丙胺类药物，能产生欣快感，增强社交能力和活力，常被年轻人用作“周末”娱乐性药物。
一名23岁男性（身高184厘米，体重68千克）因黄疸和恶心持续6天就诊于土耳其伊斯坦布尔马尔马拉大学医院急诊科。患者报告称他长期服用MDMA已2年。他还报告说，在就诊前1周，他同时服用了两倍（2片）于平常剂量（1片）的该药物。进行了血液检查，血液学检查结果如下：天冬氨酸转氨酶（AST）1423 U/L（参考范围10 - 37 U/L）；丙氨酸转氨酶（ALT）2748 U/L（10 - 40 U/L）；碱性磷酸酶271 U/L（0 - 270 U/L）；γ-谷氨酰转肽酶124 U/L（7 - 49 U/L）；总胆红素13.23 mg/dL（0.2 - 1 mg/dL）；直接胆红素8.75 mg/dL（0 - 0.3 mg/dL）；淀粉酶80 U/L（0 - 220 U/L）；凝血酶原时间21.2秒；活化部分凝血活酶时间37.3秒；国际标准化比值1.66。发现肝酶和胆红素水平极高（AST为正常的40倍，ALT为正常的70倍，胆红素为正常的13倍）。排除了病毒、自身免疫和代谢性病因。甲型、乙型和丙型肝炎病毒、单核细胞增多症、巨细胞病毒和HIV感染的血清学检查均为阴性。诊断为摇头丸所致中毒性肝炎。患者的病史进一步显示，此次事件实际上是他第二次出现与摄入更高剂量（他同时摄入的MDMA剂量是平常的两倍）相关的黄疸和急性肝炎。开始进行支持性治疗（静脉输注生理盐水和生命体征监测），并每天监测肝酶、胆红素水平和凝血酶原时间。所有指标在2周内均恢复到正常水平。
MDMA，即娱乐性药物摇头丸，可能是急性肝炎和/或急性肝衰竭的病因，尤其是在年轻人中。医生可能需要警惕年轻患者中出现摇头丸所致肝损伤的可能性，尽管需要排除其他肝毒素的存在和其他诊断。对于病因不明的严重肝炎年轻患者，应调查其是否使用过这种药物。
