烟酸治疗期间的肝内胆汁淤积

Intrahepatic cholestasis during nicotinic acid therapy.

作者信息

Patel S D, Taylor H C

机构信息

Division of Endocrinology, Lutheran Medical Center, Cleveland, OH 44113.

出版信息

Cleve Clin J Med. 1994 Jan-Feb;61(1):70-5; quiz 80-2. doi: 10.3949/ccjm.61.1.70.

DOI:10.3949/ccjm.61.1.70

PMID:8124850

Abstract

BACKGROUND

Nicotinic acid, widely used to lower serum cholesterol levels, may rarely cause cholestatic jaundice.

SUMMARY

A 61-year-old white man with hypercholesterolemia complained of marked pruritus and became jaundiced after taking 3.0 g of crystalline nicotinic acid daily for 13 months. His total serum bilirubin level was increased at 144 mumol/L (8.4 mg/dL) and his alkaline phosphatase level was markedly elevated at 35.00 mukat/L (2100 U/L). Endoscopic retrograde cholangiopancreatography failed to demonstrate an obstructive lesion in the extrahepatic biliary system, computed tomography showed no intrahepatic dilatation, and ultrasonographic studies of the liver, gallbladder, and pancreas were normal; these factors all suggest intrahepatic cholestasis. Symptoms improved and liver function test results returned to normal within 51 days after stopping the drug.

CONCLUSIONS

Nicotinic acid-induced cholestatic jaundice may not be as rare as previously thought, and physicians should observe their patients for it.

摘要

背景

烟酸广泛用于降低血清胆固醇水平，但可能很少引起胆汁淤积性黄疸。

总结

一名61岁的高胆固醇血症白人男性，在每日服用3.0克结晶烟酸13个月后，出现严重瘙痒并出现黄疸。他的血清总胆红素水平升至144微摩尔/升（8.4毫克/分升），碱性磷酸酶水平显著升高至35.00微卡/升（2100国际单位/升）。内镜逆行胰胆管造影未能显示肝外胆管系统存在阻塞性病变，计算机断层扫描未显示肝内扩张，肝脏、胆囊和胰腺的超声检查均正常；这些因素均提示肝内胆汁淤积。停药后51天内症状改善，肝功能检查结果恢复正常。