Syafira Naura, Graudins Andis, Yarema Mark, Wong Anselm
Department of Medicine, School of Clinical Science at Monash Health, Monash University, Victoria, Australia.
Faculty of Medicine, Universitas Indonesia, Special Capital Region of Jakarta, Indonesia.
Clin Toxicol (Phila). 2022 Apr;60(4):478-485. doi: 10.1080/15563650.2021.1998518. Epub 2021 Nov 11.
Some studies have reported that early administration of acetylcysteine using a 3-bag regimen may not fully prevent development of liver injury in some patients. We compared the incidence of acute liver injury (ALI) in patients receiving acetylcysteine within eight hours of ingestion between the two-bag acetylcysteine regimen (200 mg/kg over four hours, 100 mg/kg over 16 h) and the three-bag regimen (150 mg/kg over 1 h, 50 mg/kg over 4 h, 100 mg/kg over 16 h).
This was a retrospective cohort study of the two-bag and three-bag acetylcysteine regimens from Monash Health, Victoria, Australia (2009-2020), compared to the three-bag acetylcysteine regimen data from the Canadian Acetaminophen Overdose Study (CAOS) database (1980-2005). The inclusion criteria included patients with an acute single ingestion of paracetamol; normal aminotransferases on presentation and acetylcysteine administered within eight hours post-overdose. The primary outcome was development of ALI (defined as: peak aminotransferase >150 IU/L).
At Monash Health, 191 patients were treated with the two-bag acetylcysteine regimen, and 180 patients with the three-bag regimen. The CAOS cohort provided 515 patients treated with the three-bag regimen. ALI developed in 1.6% (3/191) of the two-bag Monash Health group, 2.2% (4/180) of the three-bag Monash Health group (difference -0.6%, p 0.7), and 2.9% (15/515) of the three-bag CAOS group (difference compared to two-bag -1.3%, p 0.4). Hepatotoxicity (ALT >1000) developed in 0.5% (1/191) of patients treated with the two-bag regimen, 1.7% (3/180) in the Monash Health three-bag regimen and 1% (5/515) of the three-bag CAOS group. There were no statistically significant differences between groups.
ALI and hepatotoxicity were observed in a small, comparable percentage of patients despite early acetylcysteine administration using the two-bag and three-bag regimens. Repeating blood tests at the end of acetylcysteine treatment will identify these patients and indicate those requiring continuation of acetylcysteine.
一些研究报告称，采用三袋给药方案早期给予乙酰半胱氨酸可能无法完全预防某些患者发生肝损伤。我们比较了两袋乙酰半胱氨酸给药方案（4小时内给予200mg/kg，16小时内给予100mg/kg）和三袋给药方案（1小时内给予150mg/kg，4小时内给予50mg/kg，16小时内给予100mg/kg）在摄入后8小时内接受乙酰半胱氨酸治疗的患者中急性肝损伤（ALI）的发生率。
这是一项对澳大利亚维多利亚州莫纳什健康中心（2009 - 2020年）两袋和三袋乙酰半胱氨酸给药方案的回顾性队列研究，并与加拿大对乙酰氨基酚过量研究（CAOS）数据库（1980 - 2005年）中的三袋乙酰半胱氨酸给药方案数据进行比较。纳入标准包括急性单次摄入对乙酰氨基酚的患者；就诊时转氨酶正常且在过量摄入后8小时内给予乙酰半胱氨酸。主要结局是发生ALI（定义为：转氨酶峰值>150IU/L）。
在莫纳什健康中心，191例患者接受两袋乙酰半胱氨酸给药方案治疗，180例患者接受三袋给药方案治疗。CAOS队列提供了515例接受三袋给药方案治疗的患者。莫纳什健康中心两袋给药组中1.6%（3/191）发生ALI，三袋给药组中2.2%（4/180）发生ALI（差异为 - 0.6%，p>0.7），CAOS三袋给药组中2.9%（15/515）发生ALI（与两袋给药组相比差异为 - 1.3%，p>0.
