Chronic Acetaminophen Exposure in Pediatric Acute Liver Failure
Chronic Acetaminophen Exposure in Pediatric Acute Liver Failure
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DOI：
10.1542/peds.2011-3035
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发表时间：
2013-03-01
期刊：
影响因子：
8
通讯作者：
Squires, Robert H.
中科院分区：
文献类型：
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作者：
Leonis, Mike A.;Alonso, Estella M.;Squires, Robert H.
背景：对乙酰氨基酚(N-乙酰-对氨基酚，APAP)是一种广泛使用的可引起肝毒性的药物。在跨国儿科急性肝功能衰竭(PALF)研究中，我们研究了慢性APAP暴露(CE)儿童的特征和结局。方法：从2002年到2009年，共有895名儿童根据APAP暴露史分为：CE(接受多剂量；n=83)、单剂暴露(SE；n=85)和不暴露(NE；n=498)。CE为配对比较的参照组。结果：CE患者比SE患者年轻(3.5岁比15.2岁，P&t；.0001)，较少女性(46%比82%，P<；.0001)，更有可能是西班牙裔(25%比7%，P=.001)，但他们与NE组没有显著差异。在登记时，CE组的总胆红素低于NE组(3.2vs13.1 mg/dL，P<；.001)。谷丙转氨酶水平CE组高于NE组(2384vs855IU/L，P<；0.0001)，但低于SE组(5140IU/L，P<；0.0001)。CE21天无肝移植存活率低于SE组(68%比92%，P=.0004)，但好于NE组(49%，P=0.008)。结论：在PALF研究中，CE组儿童的胆红素水平低于NE组，丙氨酸氨基转移酶水平高于NE组。CE组预后差于SE组，但好于NE组。应该探索这种结果优于非APAP暴露的受试者的潜在原因。儿科2013；131：e740-e746
BACKGROUND: Acetaminophen (N-acetyl-p-aminophenol [APAP]) is a widely used medication that can cause hepatotoxicity. We examined characteristics and outcomes of children with chronic exposure (CE) to APAP in the multinational Pediatric Acute Liver Failure (PALF) Study.METHODS: A total of 895 children enrolled from 2002 to 2009 were grouped by APAP exposure history as: CE (received multiple doses >= 2 days; n = 83), single dose exposure (SE; n = 85), and no exposure (NE; n = 498). CE was the reference group for pairwise comparisons. Median values are shown.RESULTS: Patients with CE compared with those with SE were younger (3.5 vs 15.2 years, P < .0001), less likely to be female (46% vs 82%, P < .0001), and more likely to be Hispanic (25% vs 7%, P = .001), but they did not differ significantly from the NE group. At enrollment, total bilirubin was lower with CE than with NE (3.2 vs 13.1 mg/dL, P < .001). Alanine aminotransferase levels were higher with CE than with NE (2384 vs 855 IU/L, P < .0001), but lower than with SE (5140 IU/L, P < .0001). Survival without liver transplantation at 21 days was worse for CE than for SE (68% vs 92%, P = .0004) but better than for NE (49%, P = .008).CONCLUSIONS: Children in the PALF study with CE had lower bilirubin and higher alanine aminotransferase than those with NE. Outcomes with CE were worse than with SE but better than with NE. Potential reasons for this outcomes advantage over non-APAP-exposed subjects should be explored. Pediatrics 2013; 131:e740-e746