Larrey D, Pessayre D, Duhamel G, Casier A, Degott C, Feldmann G, Erlinger S, Benhamou J P
J Hepatol. 1986;2(1):81-7. doi: 10.1016/s0168-8278(86)80011-3.
We report the cases of 3 patients in whom ajmaline-induced acute hepatitis was followed by anicteric cholestasis persisting for more than 1 year after cessation of administration of the drug. Ajmaline was given for 8-16 days before the onset of acute hepatitis. Jaundice was preceded by fever, chills and abdominal pain, and was associated with hypereosinophilia. The initial lesions included centrilobular cholestasis and portal inflammatory infiltration. Jaundice lasted for 3 weeks to 11 months. In these 3 patients liver tests were still abnormal 17-26 months after ajmaline withdrawal; histological examination, performed 9-26 months after the onset of jaundice, showed a decreased number of interlobular bile ducts, ductular proliferation, and mild portal fibrosis; circulating immune complexes were demonstrated. These observations demonstrate that prolonged cholestasis can follow ajmaline-induced acute hepatitis. Persistence of cholestasis long after the withdrawal of ajmaline suggests some form of autoimmunity.
我们报告了3例患者的病例，这些患者在使用阿义马林后发生急性肝炎，在停药后出现持续超过1年的无黄疸型胆汁淤积。在急性肝炎发作前，阿义马林给药8 - 16天。黄疸出现前有发热、寒战和腹痛，并伴有嗜酸性粒细胞增多。最初的病变包括小叶中心性胆汁淤积和门管区炎症浸润。黄疸持续3周至11个月。在这3例患者中，停药17 - 26个月后肝功能检查仍异常；在黄疸出现9 - 26个月后进行的组织学检查显示小叶间胆管数量减少、小胆管增生和轻度门管区纤维化；检测到循环免疫复合物。这些观察结果表明，阿义马林诱导的急性肝炎后可出现长期胆汁淤积。阿义马林停药后胆汁淤积长期持续提示存在某种形式的自身免疫。
