Thomas E, Bhuta S, Rosenthal W S
Arch Pathol Lab Med. 1976 Mar;100(3):132-5.
A 55-year-old woman developed symptoms suggestive of hepatitis 12 weeks after first receiving methyldopa for hypertension. Liver biopsy showed chronic aggressive hepatitis with subacute hepatic necrosis. Methyldopa was discontinued, but after exhibiting transient clinical improvement, the patient's condition progressively deteriorated until she died of hepatic failure, in spite of therapy with massive doses of corticosteroids and other nonspecific measures. During the terminal stage, a considerable decrease in the size of the liver was observed. At autopsy, the liver was found to be small, shrunken, and scarred; histological sections demonstrated postnecrotic cirrhosis. Such a rapid and relentless progression of methyldopa-induced liver injury is undoubtedly rare, but it may be prevented by careful supervision of patients who exhibit liver function abnormalities early in the course of therapy.
一名55岁女性在首次接受甲基多巴治疗高血压12周后出现提示肝炎的症状。肝活检显示为慢性侵袭性肝炎伴亚急性肝坏死。停用甲基多巴后，尽管患者临床症状有短暂改善，但病情仍逐渐恶化，最终死于肝功能衰竭，尽管接受了大剂量皮质类固醇治疗和其他非特异性治疗措施。在终末期，观察到肝脏体积明显缩小。尸检发现肝脏小、萎缩且有瘢痕形成；组织学切片显示为坏死后肝硬化。甲基多巴所致肝损伤如此迅速且无情的进展无疑罕见，但通过在治疗过程早期对出现肝功能异常的患者进行仔细监测，或许可以预防这种情况。
