Guzzini F, Banfi L, Gomitoni A, Marchegiani C, Novati P, Mesina M, Frigerio B
Servizio di Accettazione e Pronto Soccorso, USSL, Ospedale, Saronno (Varese).
Recenti Prog Med. 1997 Mar;88(3):124-7.
We report the case of two patients suffered from cholestatic jaundice occurred 3-4 weeks after starting ticlopidine therapy. In both cases the diagnosis was made by ruling out any other known cause of acute hepatitis or cholestasis. One patient underwent liver biopsy, which showed a typical intralobular cholestatic pattern and a slight lymphocytic infiltration of the portal tracts. The other patient, a 29 year-old woman, was taking ticlopidine as the sole drug, further to an ischemic stroke occurred while she was taking oral contraceptives; she presented a diffuse itchy dermatitis, fever and slight eosinophilia besides cholestasis. In both patients ticlopidine was discontinued and liver tests returned to normal values within 4-8 weeks; no rechallenge was attempted and ticlopidine was replaced with another antiplatelet drug. To the best of our knowledge 19 cases of ticlopidine-related cholestatic disease have been described so far in the literature. Its pathogenesis is still unknown, although some clinical findings and experimental results from patients with acute enteropathy or agranulocytosis induced by ticlopidine suggest that the drug may act through a toxic mechanism, perhaps mediated by prostaglandins.
我们报告了两例患者的病例，他们在开始使用噻氯匹定治疗3 - 4周后出现胆汁淤积性黄疸。在这两例病例中，通过排除急性肝炎或胆汁淤积的任何其他已知病因做出诊断。其中一名患者接受了肝活检，结果显示典型的小叶内胆汁淤积模式以及门管区轻度淋巴细胞浸润。另一名患者是一位29岁女性，在服用口服避孕药时发生缺血性中风后，仅服用噻氯匹定；除胆汁淤积外，她还出现了弥漫性瘙痒性皮炎、发热和轻度嗜酸性粒细胞增多。两名患者均停用了噻氯匹定，肝功能检查在4 - 8周内恢复到正常水平；未尝试再次用药，噻氯匹定被另一种抗血小板药物替代。据我们所知，迄今为止，文献中已描述了19例与噻氯匹定相关的胆汁淤积性疾病病例。其发病机制仍不清楚，尽管噻氯匹定诱导的急性肠病或粒细胞缺乏症患者的一些临床发现和实验结果表明，该药物可能通过毒性机制起作用，也许是由前列腺素介导的。
