James O, Lesna M, Roberts S H, Pulman L, Douglas A P, Smith P A, Watson A J
Lancet. 1975 Sep 27;2(7935):579-81. doi: 10.1016/s0140-6736(75)90170-1.
54 patients have been studied after paracetamol (acetaminophen) overdose. Liver-function tests and fasting serum bile-acids were measured daily; liver biopsy was done in all cases, and slides were examined "blind" to assess liver damage. The plasma-paracetamol was measured on one occasion. A histological abnormality was present in the livers of 53 of the 54 patients, and was minor in 23, moderate in 16, and severe in 14. In 6 patients with moderate and 18 with mild histological abnormality liver-function tests were normal. A serum-aspartate-aminotransferase above 400 units/1 was always associated with severe histological liver damage. Fasting serum bile-acids were raised in 51 of the patients with abnormal liver histology; the serum-bile-acid seemed to be a more sensitive indicator of mild liver-cell damage than was the transaminase level. There was, however, little correlation between increase in bile-acid concentration and the degree of histological abnormality. As a result of these investigations empirically determined levels of plasma-paracetamol have been drawn which give a guide to the likelihood of liver damage after paracetamol overdose.
对54例扑热息痛（醋氨酚）过量患者进行了研究。每天测定肝功能试验和空腹血清胆汁酸；所有病例均进行肝活检，并对切片进行“盲法”检查以评估肝损伤。仅一次测定血浆扑热息痛水平。54例患者中有53例肝脏存在组织学异常，其中23例为轻度，16例为中度，14例为重度。6例中度和18例轻度组织学异常患者的肝功能试验正常。血清天冬氨酸转氨酶高于400单位/升总是与严重的肝脏组织学损伤相关。51例肝脏组织学异常患者的空腹血清胆汁酸升高；血清胆汁酸似乎比转氨酶水平更能敏感地指示轻度肝细胞损伤。然而，胆汁酸浓度的升高与组织学异常程度之间几乎没有相关性。通过这些研究，已经得出了根据经验确定的血浆扑热息痛水平，可为扑热息痛过量后肝损伤的可能性提供指导。
