AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Aliment Pharmacol Ther. 2024 Apr;59(8):953-961. doi: 10.1111/apt.17906. Epub 2024 Feb 19.
Reports of DILI due to herbal and dietary supplements have been increasing over time.
To characterise clinical, laboratory and histopathological phenotypes and outcomes of drug-induced liver injury (DILI) due to anabolic-androgenic steroids (AAS), selective androgen receptor modulators (SARMs), and bodybuilding supplements (BBS) in Australia.
Retrospective case series. Patients presented to nine Australian tertiary hospitals, 2017-2023. DILI was defined biochemically and patients were included if their treating physician attributed DILI to preceding use of AAS, SARMs or BBS. Primary endpoint was time to normalisation of liver biochemistry. Secondary endpoints were hospitalisation for investigation or management of DILI, death attributable to liver injury, and liver transplantation.
Twenty-three cases of DILI were identified, involving 40 drugs: 18 AAS, 14 SARMs and eight BBS. Patients were predominantly male (22/23), with median age 30 years (IQR 26-42). Most were symptomatic (21/23). Median latency of onset was 58 days (IQR 28-112 days) from drug commencement. Most patients (17/23) were admitted to hospital. Based on updated Roussel Uclaf Causality Assessment Method, DILI was possible in 17/23, probable in 2/23 and unlikely in 4/23. Median time to normalisation of liver biochemistry was 175 days (IQR 70-292 days) from presentation. Three (3/23) were treated with corticosteroids, 14/23 were treated for itch, and one (1/23) underwent liver transplantation. There were no deaths.
The prognosis of DILI from AAS, SARMs and BBS is good although liver transplantation may rarely be required. A detailed drug history is important in uncovering DILI due to these supplements.
随着时间的推移，草药和膳食补充剂导致的 DILI 报告不断增加。
描述澳大利亚合成代谢雄激素类固醇（AAS）、选择性雄激素受体调节剂（SARMs）和健身补充剂（BBS）导致的药物性肝损伤（DILI）的临床、实验室和组织病理学表型及结局。
回顾性病例系列。2017 年至 2023 年，患者在澳大利亚的 9 家三级医院就诊。DILI 通过生化指标定义，如果他们的治疗医生认为 DILI 是由之前使用 AAS、SARMs 或 BBS 引起的，则纳入患者。主要终点是肝功能生化指标正常化的时间。次要终点是因 DILI 进行调查或治疗而住院、归因于肝损伤的死亡和肝移植。
共确定了 23 例 DILI 病例，涉及 40 种药物：18 种 AAS、14 种 SARMs 和 8 种 BBS。患者均为男性（22/23），中位年龄 30 岁（IQR 26-42）。大多数患者有症状（21/23）。药物开始后中位潜伏期为 58 天（IQR 28-112 天）。大多数患者（17/23）住院。根据更新的 Roussel Uclaf Causality Assessment Method，23 例患者中，17 例为可能、2 例为很可能、4 例为不太可能。从就诊到肝功能生化指标正常化的中位时间为 175 天（IQR 70-292 天）。3 例（3/23）患者接受了皮质类固醇治疗，14 例（14/23）患者接受了瘙痒治疗，1 例（1/23）患者接受了肝移植。无死亡病例。
尽管可能需要进行肝移植，但 AAS、SARMs 和 BBS 引起的 DILI 预后良好。详细的药物史对于发现这些补充剂引起的 DILI 很重要。
