Ellis A J, Wendon J A, Portmann B, Williams R
Institute of Liver Studies, King's College School of Medicine and Dentistry, London.
Gut. 1996 Mar;38(3):454-8. doi: 10.1136/gut.38.3.454.
Eight cases of ecstasy related acute liver damage referred to a specialised liver unit are described. Two patients presented after collapse within six hours of ecstasy ingestion with hyperthermia, hypotension, fitting, and subsequently disseminated intravascular coagulation with rhabdomyolysis together with biochemical evidence of severe hepatic damage. One patient recovered and the other with evidence of hyperacute liver failure was transplanted but subsequently died, histological examination showing widespread microvesicular fatty change. Four patients presented with acute liver failure without hyperthermia. All four fulfilled criteria for transplantation, one died before a donor organ became available, and two died within one month post-transplantation of overwhelming sepsis. Histological examination showed submassive lobular collapse. Two patients presented with abdominal pain and jaundice and recovered over a period of three weeks; histological examination showed a lobular hepatitis with cholestasis. Patients developing jaundice or with evidence of hepatic failure particularly encephalopathy and prolongation of the international normalised ratio, or both, whether or not preceded by hyperthermia, should be referred to a specialised liver unit as liver transplantation probably provides the only chance of recovery.
本文描述了8例因摇头丸导致急性肝损伤并转诊至专业肝病科的病例。2例患者在服用摇头丸后6小时内出现虚脱，伴有高热、低血压、抽搐，随后发生弥散性血管内凝血并伴有横纹肌溶解，同时有严重肝损伤的生化证据。1例患者康复，另1例有超急性肝衰竭证据的患者接受了肝移植，但随后死亡，组织学检查显示广泛的微泡性脂肪变性。4例患者出现急性肝衰竭但无高热。这4例均符合肝移植标准，1例在获得供体器官前死亡，2例在肝移植后1个月内因严重败血症死亡。组织学检查显示亚大块小叶塌陷。2例患者出现腹痛和黄疸，3周内康复；组织学检查显示小叶性肝炎伴胆汁淤积。出现黄疸或有肝衰竭证据（尤其是肝性脑病和国际标准化比值延长），或两者皆有的患者，无论是否有高热前驱症状，均应转诊至专业肝病科，因为肝移植可能是唯一的康复机会。
