Acute liver damage and ecstasy ingestion
Acute liver damage and ecstasy ingestion
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DOI：
10.1136/gut.38.3.454
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发表时间：
1996-03-01
期刊：
影响因子：
24.5
通讯作者：
Williams, R
中科院分区：
文献类型：
--
作者：
Ellis, AJ;Wendon, JA;Williams, R
描述了八例与摇头丸相关的急性肝损伤，转至专门的肝脏病房。两名患者在服用摇头丸后六小时内昏倒，伴有高热、低血压、不适，随后出现弥散性血管内凝血并伴有横纹肌溶解，并伴有严重肝损伤的生化证据。一名患者康复，另一名有超急性肝衰竭证据的患者接受了移植，但随后死亡，组织学检查显示广泛的微泡脂肪改变。 4 名患者出现急性肝功能衰竭，但未进行高热治疗。所有四名患者均符合移植标准，一名患者在移植后存活，一名患者在供体器官可用之前死亡，两名患者在移植后一个月内死于严重败血症。组织学检查显示小叶大面积塌陷。两名患者出现腹痛和黄疸，并在三周内康复；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（特别是脑病和国际标准化比率延长，或两者兼而有之）的患者，无论是否先进行过热疗，都应转诊至专门的肝病科，因为肝移植可能是唯一的康复机会。
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 patient survived after transplantation, one died before a donor organ became available, and two died within one month posttransplantation 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.