McClain C J, Holtzman J, Allen J, Kromhout J, Shedlofsky S
Department of Medicine, Lexington VA Medical Center, Kentucky.
J Clin Gastroenterol. 1988 Feb;10(1):76-80. doi: 10.1097/00004836-198802000-00016.
Thirteen patients met our criteria for severe acetaminophen hepatotoxicity over a 5-year study period. Six patients had therapeutic misadventures (not attempting suicide), and seven were attempting suicide. Five of six patients in the therapeutic misadventure group were chronic alcoholics, and three were taking other drugs reported to cause hepatic microsomal enzyme induction. In the suicide group, two of seven patients were alcoholics, and one patient was taking another inducing drug. All six patients in the therapeutic misadventure group had nausea, vomiting, or starvation, whereas two of seven patients in the suicide group had similar characteristics. Starvation could deplete the protective factor glutathione, thus augmenting hepatotoxicity. In the therapeutic misadventure group, four of six patients developed acute tubular necrosis, as compared to two of seven in the suicide group. One patient died in each group. Clinicians should be aware of these features as part of the spectrum of acetaminophen toxicity.
在一项为期5年的研究期间，13名患者符合我们关于对乙酰氨基酚严重肝毒性的标准。6名患者发生治疗性意外（非自杀企图），7名患者企图自杀。治疗性意外组的6名患者中有5名是慢性酗酒者，3名正在服用其他据报道可导致肝微粒体酶诱导的药物。在自杀组中，7名患者中有2名是酗酒者，1名患者正在服用另一种诱导药物。治疗性意外组的所有6名患者都有恶心、呕吐或饥饿症状，而自杀组的7名患者中有2名有类似特征。饥饿会消耗保护性因子谷胱甘肽，从而增强肝毒性。在治疗性意外组中，6名患者中有4名发生急性肾小管坏死，而自杀组的7名患者中有2名发生。每组各有1名患者死亡。临床医生应知晓这些特征，将其作为对乙酰氨基酚毒性谱的一部分。
