Døssing M, Sonne J
Medical Department P, Bispebjerg Hospital, Copenhagen, Denmark.
Drug Saf. 1993 Dec;9(6):441-9. doi: 10.2165/00002018-199309060-00007.
Drug-induced liver injury has been associated with more than 800 different drugs, leading to hospital admission in 1 of 600 to 3500 admissions. This amounts to 2 to 3% of all hospitalisations due to adverse drug reactions, or about 3% of all jaundiced patients. The prognosis of clinically overt drug hepatotoxicity is relatively serious. The clinical picture is essentially nonspecific, with a highly variable latency period from days to years. Drug hepatotoxicity can mimic almost any kind of liver disease. A thorough drug history, a low threshold of suspicion and the exclusion of other causes of liver disease are important for the detection of drug-induced liver disorders. Treatment consists of discontinuation of suspected drug(s), acetylcysteine in the course of paracetamol (acetaminophen) toxicity, and liver transplantation in selected cases of fulminant liver failure. Guidelines regarding the use of selected drugs such as methotrexate and halothane should be followed. Potentially hepatotoxic drugs should be used cautiously in alcoholic patients with or without liver involvement. Patients with uncompensated liver disease should receive a reduced dose of drugs adjusted to the degree of liver function impairment. The general public should be warned against abuse of hepatotoxic drugs such as paracetamol and anabolic steroids.
药物性肝损伤与800多种不同药物有关，每600至3500例住院病例中就有1例因药物性肝损伤住院。这占药物不良反应所致所有住院病例的2%至3%，约占所有黄疸患者的3%。临床明显的药物性肝毒性预后相对严重。临床表现基本上是非特异性的，潜伏期从数天到数年不等，差异很大。药物性肝毒性几乎可以模拟任何类型的肝病。详细的用药史、较低的怀疑阈值以及排除其他肝病病因对于检测药物性肝病很重要。治疗包括停用可疑药物、对乙酰氨基酚（扑热息痛）中毒时使用乙酰半胱氨酸，以及在暴发性肝衰竭的特定病例中进行肝移植。应遵循有关使用甲氨蝶呤和氟烷等特定药物的指南。对于有或无肝脏病变的酗酒患者，应谨慎使用有潜在肝毒性的药物。失代偿性肝病患者应根据肝功能损害程度减少用药剂量。应警告公众不要滥用对乙酰氨基酚和合成代谢类固醇等肝毒性药物。
