Pariente E A, Hamoud A, Goldfain D, Latrive J P, Gislon J, Cassan P, Morin T, Staub J L, Ramain J P, Bertrand J L
Services d'Hépato-Gastroentérologie, Hôpital de la Source, Orléans.
Gastroenterol Clin Biol. 1989 Oct;13(10):769-74.
Thirty cases of clometacin-induced hepatitis were retrospectively collected over a nine-year period in hepatogastroenterological units of non university, public hospitals. There was a strong female predominance (90 percent). Clometacin (Dupéran) was taken because of arthritis in 8 out of 10 cases. Administration was continuous in 85 percent of cases and median duration was 445 days. median dose was 450 mg per day. Jaundice, fatigue, and weight loss were the most frequent symptoms, but edema, ascites and palmar erythema were not uncommon. Thrombopenia (38 percent) was the most frequent hematologic abnormality. Renal failure, always with benign course, was present in 1/4 of cases. Biochemical disorders indicated hepatocellular and cholestatic hepatitis in 3/4 and 1/4 of cases respectively. Hypoprothrombinemia below 50 percent was noted in 1 out of 6 cases, and was associated with death in half cases. Gamma-globulins were increased in 80 percent of cases, with a predominant increase of IgG. Antinuclear or anti-smooth muscle antibodies were present in 60 percent of cases, whereas antimitochondrial and antimicrosomes were absent. Histopathological examination of the liver biopsy specimens obtained in 25 patients showed acute hepatitis in 8 and chronic active hepatitis with fibrosis in 17--including 6 patients with cirrhosis; there were no epidemiological, clinical (except ascites), or biochemical differences between these two groups. Four of the 7 patients tested had HLA B8 antigens; they all had chronic active hepatitis, with autoantibodies in 3 cases. Median duration of hospitalization was 21 days. Hepatitis was directly responsible for death in 3 patients; biochemical sequelae (hypergammaglobulinemia or anicteric cholestasis) were present in 8 patients, 2 of whom most likely had cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
在九年时间里,我们对非大学附属医院的肝病胃肠病科收治的30例氯美辛所致肝炎患者进行了回顾性研究。女性占绝大多数(90%)。10例患者中有8例因关节炎服用氯美辛(Dupéran)。85%的患者持续用药,用药中位时长为445天,中位剂量为每日450毫克。黄疸、乏力和体重减轻是最常见的症状,但水肿、腹水和掌部红斑也并不少见。血小板减少症(38%)是最常见的血液学异常。四分之一的患者出现肾衰竭,不过病程均为良性。生化紊乱表明,四分之三的患者为肝细胞性肝炎,四分之一的患者为胆汁淤积性肝炎。六分之一的患者凝血酶原血症低于50%,其中半数患者死亡。80%的患者γ-球蛋白升高,以IgG升高为主。60%的患者存在抗核抗体或抗平滑肌抗体,而抗线粒体抗体和抗微粒体抗体阴性。对25例患者进行肝脏活检标本的组织病理学检查,结果显示,8例为急性肝炎,17例为伴有纤维化的慢性活动性肝炎,其中6例为肝硬化;两组在流行病学、临床(除腹水外)或生化方面无差异。7例接受检测的患者中有4例携带HLA B8抗原;他们均为慢性活动性肝炎,3例伴有自身抗体。住院中位时长为21天。3例患者的死亡直接归因于肝炎;8例患者存在生化后遗症(高球蛋白血症或无黄疸型胆汁淤积),其中2例很可能患有肝硬化。(摘要截选至250词)