Pandejpong D, Saengsuri P, Rattarittamrong R, Rujipattanakul T, Chouriyagune C
Department of Medicine, Division of Ambulatory Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
Department of Medicine, Chumphonkhetudomsakdi Hospital, Chumphon, Thailand.
Intern Med J. 2015 Jun;45(6):653-8. doi: 10.1111/imj.12756.
Dengue, an endemic infection causing severe flu-like symptoms and fever, is often treated with high-dose acetaminophen that can exceed recommended daily dosages. This leads to hepatotoxicity, although the underlying mechanism is poorly understood. We hypothesised that excessive acetaminophen causes hepatic toxicity in dengue patients.
To investigate a correlation between elevated serum transaminases and excessive acetaminophen intake, and other aggravating factors of liver injury in dengue cases.
This prospective observational study obtained blood samples from 150 participants with acute febrile illness for dengue serological tests, blood counts, and the detection of serum transaminases and acetaminophen levels. Other factors were determined by questionnaire.
Of 150 participants enrolled, 77 had dengue fever. Abnormally high serum aspartate transaminase and alanine transaminase levels were present in 97.0% and 75.3% of dengue cases respectively. Multivariate analysis of cases with increased serum transaminases more than threefold normal upper limits indicated that male gender (odds ratio (OR) = 3.62, 95% confidence interval (CI) 1.38-9.42) and consuming >8 g acetaminophen orally (OR = 4.62, 95% CI 1.37-13.18) correlated with transaminitis. No correlation was found for other factors such as age, fever day at presentation, body mass index, alcohol intake or dengue severity classification (all P > 0.05). Chronic alcohol consumption was higher in non-dengue (2.6%) versus dengue cases (27.8%) (P < 0.01).
Most dengue patients had mild-to-moderate transaminitis. Male gender and acetaminophen >8 g were associated with increased serum transaminases. Thus, 1000 mg acetaminophen every 8 h or <3000 mg/day is recommended for dengue cases. Chronic alcohol consumption might be protective against dengue infection.
登革热是一种地方性感染疾病，会引发严重的流感样症状和发热，通常使用高剂量对乙酰氨基酚进行治疗，而该剂量可能超过每日推荐用量。这会导致肝毒性，尽管其潜在机制尚不清楚。我们推测过量的对乙酰氨基酚会导致登革热患者出现肝毒性。
研究血清转氨酶升高与对乙酰氨基酚摄入过量之间的相关性，以及登革热病例中其他加重肝损伤的因素。
这项前瞻性观察性研究采集了150名急性发热疾病参与者的血样，用于登革热血清学检测、血细胞计数以及血清转氨酶和对乙酰氨基酚水平的检测。通过问卷调查确定其他因素。
在纳入的150名参与者中，77人患有登革热。登革热病例中，血清天冬氨酸转氨酶和丙氨酸转氨酶水平异常升高的分别占97.0%和75.3%。对血清转氨酶升高超过正常上限三倍的病例进行多因素分析表明，男性（比值比（OR）=3.62，95%置信区间（CI）1.38 - 9.42）以及口服对乙酰氨基酚>8克（OR = 4.62，95%CI 1.37 - 13.18）与转氨酶升高相关。未发现年龄、就诊时发热天数、体重指数、酒精摄入或登革热严重程度分级等其他因素存在相关性（所有P>0.05）。非登革热病例（2.6%）的慢性酒精消耗量低于登革热病例（27.8%）（P<0.01）。
大多数登革热患者有轻度至中度转氨酶升高。男性和对乙酰氨基酚>⑧克与血清转氨酶升高有关。因此，建议登革热病例每8小时服用1000毫克对乙酰氨基酚或每日用量<3000毫克。慢性酒精消耗可能对登革热感染有保护作用。
