Furet Y, Metman E H, Breteau M, Bertrand J
Service de Pharmacologie Clinique, CHR Bretonneau, Tours.
Ann Gastroenterol Hepatol (Paris). 1987 Dec;23(7):367-74.
The extended prescription of non-steroidal anti-inflammatory drugs in medical practice involve numerous adverse effects. Among them, hepatic injuries, rather uncommon, are very diverse with regard to clinical type and evolution scheme, according to the derivatives used. Salicylates, when taken at high doses, increase serum transaminases, mostly without overt clinical symptoms. Phenylbutazone is obviously hepatotoxic: it induces cytolytic hepatitis, in some cases with fatal issue. Among the indole derivatives, indometacine was involved, especially in children; mixed hepatitis have been noted during sulindac therapy, mostly with favourable outcome. In the group of propionic acid derivatives, ibuprofen, pirprofen and naproxen have been implicated in hepatitis of various types; ibufenac and benoxaprofen were quickly retired after occasioning several deaths. Concerning others non-steroidal anti-inflammatory drugs, some cases have been reported with piroxicam and diclofenac. Hepatotoxicity mechanisms are often unknown; they appear different according to each drug. Besides, the rheumatic disease under treatment and pharmacokinetic particularities (sulindac, diclofenac) might be important in this view. Monitoring of serum hepatic-enzyme concentrations seems recommended for patients receiving non-steroidal anti-inflammatory for long time therapy.
在医学实践中，非甾体类抗炎药的长期使用会引发诸多不良反应。其中，肝损伤虽不常见，但根据所使用的衍生物不同，其临床类型和演变模式差异很大。水杨酸盐大剂量服用时会使血清转氨酶升高，多数情况下无明显临床症状。保泰松具有明显的肝毒性：可引发细胞溶解性肝炎，某些情况下会导致死亡。在吲哚衍生物中，吲哚美辛尤其在儿童中出现过相关问题；舒林酸治疗期间曾出现混合型肝炎，多数预后良好。在丙酸衍生物组中，布洛芬、吡洛芬和萘普生都与不同类型的肝炎有关；异丁苯乙酸和苯恶洛芬在导致数例死亡后很快被停用。关于其他非甾体类抗炎药，也有一些与吡罗昔康和双氯芬酸相关的病例报道。肝毒性机制往往不明；不同药物的机制似乎有所不同。此外，正在治疗的风湿性疾病以及药代动力学特性（舒林酸、双氯芬酸）在这方面可能很重要。对于长期接受非甾体类抗炎药治疗的患者，建议监测血清肝酶浓度。
