Ryley N G, Fleming K A, Chapman R W
Nuffield Department of Pathology and Bacteriology, John Radcliffe Hospital, Headington, Oxford, UK.
J Hepatol. 1995 Sep;23(3):278-82.
Amoxycillin/clavulanic acid (Augmentin) has been widely used as a broad spectrum antibiotic since its introduction in 1981, since which time a number of reports of adverse hepatic reaction to the drug combination have been published. This paper describes five patients presenting with cholestatic illness within 8 weeks of a course of amoxycillin/clavulanic acid. The clinical picture indicated a direct link between the illness and the drug combination. Hepatic histology revealed a distinctive focal destructive cholangiopathy in all five patients, which has not previously been reported. Two also showed a granulomatous reaction, which has only previously been reported in one patient. Parallels are drawn with other diseases displaying bile duct destruction, and it is suggested that immunologically mediated drug-induced biliary damage may be involved. One of the five patients developed chronic liver disease with persistence of cholestatic liver biochemical tests, which has not previously been reported. The severity of the reaction and its prolonged course merit wider recognition of the possible adverse hepatic reaction to amoxycillin/clavulanic acid.
阿莫西林/克拉维酸（安灭菌）自1981年上市以来，作为一种广谱抗生素被广泛使用，自那时起，已有多篇关于该药物组合引起肝脏不良反应的报道发表。本文描述了5例在接受阿莫西林/克拉维酸治疗疗程的8周内出现胆汁淤积性疾病的患者。临床表现表明该疾病与药物组合之间存在直接联系。肝脏组织学检查显示，所有5例患者均有独特的局灶性破坏性胆管病，此前未见报道。其中2例还出现了肉芽肿反应，此前仅在1例患者中报道过。文中将其与其他表现为胆管破坏的疾病进行了对比，并提示可能涉及免疫介导的药物性胆管损伤。5例患者中有1例发展为慢性肝病，胆汁淤积性肝脏生化检查持续异常，此前未见报道。该反应的严重性及其病程延长值得更广泛地认识到阿莫西林/克拉维酸可能引起的肝脏不良反应。
