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[氯美辛(杜佩兰)所致肝炎。30例回顾性研究。自身免疫性药物性肝炎模型?]

[Hepatitis caused by clometacin (Dupéran). Retrospective study of 30 cases. A model of autoimmune drug-induced hepatitis?].

作者信息

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

机构信息

Services d'Hépato-Gastroentérologie, Hôpital de la Source, Orléans.

出版信息

Gastroenterol Clin Biol. 1989 Oct;13(10):769-74.

PMID:2687071
Abstract

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)

摘要

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)

相似文献

1
[Hepatitis caused by clometacin (Dupéran). Retrospective study of 30 cases. A model of autoimmune drug-induced hepatitis?].[氯美辛(杜佩兰)所致肝炎。30例回顾性研究。自身免疫性药物性肝炎模型?]
Gastroenterol Clin Biol. 1989 Oct;13(10):769-74.
2
Characteristics of clometacin-induced hepatitis with special reference to the presence of anti-actin cable antibodies.氯灭酸诱导性肝炎的特征,特别提及抗肌动蛋白束状纤维抗体的存在
Autoimmunity. 1989;2(3):213-21. doi: 10.3109/08916938909014685.
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[Acute hepatitis caused by clometacin. Value of the assay of antinuclear and anti-smooth muscle antibodies].[氯美辛所致急性肝炎。抗核抗体及抗平滑肌抗体检测的价值]
Gastroenterol Clin Biol. 1983 Mar;7(3):318-9.
4
[Acute renal failure and hepatitis induced by clometacin].[氯美辛引起的急性肾衰竭和肝炎]
Gastroenterol Clin Biol. 1984 Mar;8(3):264-8.
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Chronic active hepatitis and giant multinucleated hepatocytes in adults treated with clometacin.
Digestion. 1981;22(2):66-72. doi: 10.1159/000198597.
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[Hepatitis caused by clometacin and asymptomatic primary biliary cirrhosis].[氯美辛所致肝炎与无症状原发性胆汁性肝硬化]
Ann Gastroenterol Hepatol (Paris). 1989 Nov;25(6):259-60.
7
[Clometacin, chronic active hepatitis and markers of autoimmunity].
Gastroenterol Clin Biol. 1982 Aug-Sep;6(8-9):715-6.
8
Drug-induced hepatitis associated with anticytoplasmic organelle autoantibodies.与抗细胞质细胞器自身抗体相关的药物性肝炎
Hepatology. 1985 Sep-Oct;5(5):722-7. doi: 10.1002/hep.1840050504.
9
[Chronic active hepatitis caused by clometacin ; 2 cases].[氯美辛引起的慢性活动性肝炎;2例]
Gastroenterol Clin Biol. 1981 Nov;5(11):1068-9.
10
[Chronic active hepatitis associated with anti-native DNA antibodies: incidence of drug etiology].[与抗天然DNA抗体相关的慢性活动性肝炎:药物病因的发生率]
Gastroenterol Clin Biol. 1984 Nov;8(11):833-7.

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In silico analysis of HLA associations with drug-induced liver injury: use of a HLA-genotyped DNA archive from healthy volunteers.
药物性肝损伤与 HLA 关联的计算机分析:利用健康志愿者 HLA 基因分型 DNA 档案。
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Drug-induced autoimmune-like hepatitis.药物诱导的自身免疫性肝炎。
Dig Dis Sci. 2011 Apr;56(4):958-76. doi: 10.1007/s10620-011-1611-4. Epub 2011 Feb 16.
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Autoimmune hepatitis and thyroiditis associated with rifampin and pyrazinamide prophylaxis: an unusual reaction.与利福平及吡嗪酰胺预防性用药相关的自身免疫性肝炎和甲状腺炎:一种罕见反应。
Dig Dis Sci. 2005 Jan;50(1):207-11. doi: 10.1007/s10620-005-1302-0.
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HLA-A33/B44/DR6 is highly related to intrahepatic cholestasis induced by tiopronin.HLA - A33/B44/DR6与硫普罗宁诱导的肝内胆汁淤积高度相关。
Dig Dis Sci. 2000 Jun;45(6):1103-8. doi: 10.1023/a:1005585515826.
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Drug-induced "allergic hepatitis".药物性“过敏性肝炎”。
Clin Rev Allergy Immunol. 1995 Fall;13(3):223-44. doi: 10.1007/BF02771763.