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药物滥用者的肝脏疾病

Liver disorders in substance abusers.

作者信息

Zacharia George Sarin, Jacob Anu

机构信息

Department of Internal Medicine and Gastroenterology, Ahalia Hospital, Abu Dhabi, UAE.

Department of Anesthesiology, Ahalia Hospital, Abu Dhabi, UAE.

出版信息

Hepatol Forum. 2024 Sep 10;6(1):34-40. doi: 10.14744/hf.2024.2024.0012. eCollection 2025.

Abstract

Substance use disorders are a global health problem with detrimental effects on one's health, wealth, and stealth. It includes the use of prescribed medications or the use of illicit drugs in excess amounts or for excess durations associated with complex neuropsychiatric and/or physical manifestations. It affects every organ in the body, and the liver is no exception to the deleterious effects of substance abuse. The mechanism of liver injury varies from agent to agent and may include direct toxic effects, oxidative stress, and inflammatory responses. The hepatic involvement ranges from asymptomatic liver enzyme elevation and fatty liver disease to hepatitis, liver failure, and cirrhosis. Alcohol, the most frequent agent implicated in substance use disorder, is also a prototype hepatotoxin, capable of inducing the whole spectrum of liver diseases. Cigarette smoke contains numerous harmful chemicals, including carcinogens, which can induce liver injury, fibrosis, and HCC. Cocaine, particularly in acute overdose, can result in ischemic hepato-necrosis, while it can also result in clinically inapparent transaminasemia. Marijuana and opiates, despite being associated with numerous deleterious effects, are rarely implicated in clinically apparent liver injury. Individuals with substance use disorder are also prone to viral hepatitis and hepatic insults secondary to hypotension, hypoxia, and other systemic ailments. Liver transplant candidacy in individuals with substance use disorder is a highly complex arena, with guidelines balancing abstinence requirements against evolving evidence on outcomes. This review article provides a thorough analysis of the hepatotoxic repercussions stemming from the agents commonly implicated in substance abuse disorders.

摘要

物质使用障碍是一个全球性的健康问题,会对人的健康、财富和生活产生有害影响。它包括过量使用处方药或非法药物,或使用时间过长,从而引发复杂的神经精神和/或身体表现。它会影响身体的每个器官,滥用物质的有害影响对肝脏也不例外。肝损伤的机制因药物而异,可能包括直接毒性作用、氧化应激和炎症反应。肝脏受累范围从无症状的肝酶升高和脂肪肝疾病到肝炎、肝衰竭和肝硬化。酒精是物质使用障碍中最常见的相关药物,也是一种典型的肝毒素,能够引发各种肝脏疾病。香烟烟雾含有多种有害化学物质,包括致癌物,可导致肝损伤、纤维化和肝癌。可卡因,尤其是急性过量使用时,可导致缺血性肝坏死,同时也可导致临床上不易察觉的转氨酶升高。大麻和阿片类药物,尽管与许多有害影响有关,但很少与明显的临床肝损伤有关。患有物质使用障碍的个体也容易感染病毒性肝炎,以及因低血压、缺氧和其他全身性疾病导致的肝脏损伤。患有物质使用障碍的个体的肝移植候选资格是一个高度复杂的领域,相关指南需要在戒酒要求与不断发展的关于治疗结果的证据之间取得平衡。这篇综述文章对物质滥用障碍中常见药物引起的肝毒性后果进行了全面分析。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5e49/12008456/18c35acdc6d8/hf-6-034-g001.jpg

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