Pessayre D, Bentata M, Degott C, Nouel O, Miguet J P, Rueff B, Benhamou J P
Gastroenterology. 1977 Feb;72(2):284-9.
The authors report 6 cases of fulminant hepatitis in patients treated with isoniazid and rifampin. In 4 of these patients, the treatment had been started within 3 days after a general anesthesia. The course of the disease was remarkably similar in all 6 patients: (1) the time interval from the beginning of the isoniazid-rifampin administration to the onset of jaundice was 6 to 10 days; (2) disorders of consciousness appeared less than 3 days after the onset of jaundice; (3) serum transaminases were 26 to 80 times the upper limit of normal; (4) the main liver lesion was centrilobular necrosis; (5) hypersensitivity manifestations were absent; (6) all 6 patients recovered. Fulminant hepatitis might be attributable to a hepatotoxic metabolite of isoniazid, the production of which would be attributable to a hepatotoxic metabolite of isoniazid, the production of which would be increased as a consequence of the enzyme-inducing effect of rifampin and, possibly, other drugs administered for general anesthesia.
作者报告了6例接受异烟肼和利福平治疗的暴发性肝炎患者。在其中4例患者中，治疗在全身麻醉后3天内开始。所有6例患者的病程显著相似：（1）从开始给予异烟肼-利福平到出现黄疸的时间间隔为6至10天；（2）意识障碍在黄疸出现后不到3天出现；（3）血清转氨酶为正常上限的26至80倍；（4）主要肝脏病变为小叶中心坏死；（5）无过敏表现；（6）所有6例患者均康复。暴发性肝炎可能归因于异烟肼的一种肝毒性代谢产物，其产生可能是由于利福平以及可能用于全身麻醉的其他药物的酶诱导作用导致异烟肼肝毒性代谢产物的生成增加。
