Significance of Alanine Aminotransferase Levels in Patients Admitted for Cocaine Intoxication
Significance of Alanine Aminotransferase Levels in Patients Admitted for Cocaine Intoxication
复制标题
DOI：
10.1097/mcg.0000000000000056
复制
发表时间：
2015-03-01
影响因子：
2.9
通讯作者：
Schiavon, Leonardo L.
中科院分区：
文献类型：
--
作者：
Guollo, Fernanda;Nareiso-Schiavon, Janaina L.;Schiavon, Leonardo L.
背景：动物模型实验研究和人类病例报告描述了可卡因的肝毒性潜力。然而，很少有关于可卡因中毒患者的临床和实验室特征的数据，特别是关于肝酶的状态：目的：探讨丙氨酸氨基转移酶（ALT）水平在急性可卡因中毒住院治疗的个人的意义。方法：回顾性研究，包括2003年1月至2010年12月之间收治的患者的标准化图表审查。采用双变量分析，根据性别调查ALT高于上三分位数的相关因素。结果：共纳入93例患者（79%为男性，平均年龄27.73 ± 9.97岁）。ALT高于上三分位数与天冬氨酸转氨酶（AST）、肌酸磷酸激酶、肌酐和国际标准化比值升高相关。ALT水平升高也与急性肾衰竭和死亡有关。5例受试者在随访期间出现重度ALT升高，并且均存在肝细胞功能障碍（黄疸、凝血酶原时间延长伴或不伴肝性脑病）、横纹肌溶解和急性肾衰竭的证据。AST/ALT比2观察3例急性肝损伤进展的证据：在急性可卡因中毒，ALT水平较高的证据与肌肉损伤，进展为急性肾功能衰竭，死亡。在5%的样本中观察到重度肝损伤，所有病例均与横纹肌溶解和肾衰竭相关。
Background: Experimental studies in animal models and case reports in humans have described the hepatotoxic potential of cocaine. However, there are few data regarding the clinical and laboratory characteristics of patients admitted for cocaine intoxication, particularly regarding the status of the liver enzymes.Goal: To investigate the significance of alanine aminotransferase (ALT) levels in individuals hospitalized for acute cocaine intoxication.Methods: Retrospective study with standardized chart review that included patients admitted between January 2003 and December 2010. Bivariate analyses were used to investigate factors associated with ALT above the upper tertile according to gender. Cases of marked ALT elevation were described in detail.Results: Ninety-three patients were included (79% men, mean age of 27.73 +/- 9.97 y). ALT above the upper tertile was associated with higher aspartate aminotransferase (AST), creatine phosphokinase, creatinine, and international normalized ratio. Higher levels of ALT were also related to acute renal failure and death. Five subjects had severe ALT elevation during follow-up and all had evidence of hepatocellular dysfunction (jaundice, prolonged prothrombin time with or without hepatic encephalopathy), rhabdomyolysis, and acute renal failure. AST/ALT ratio 2 was observed in 3 cases with evidence of progression to acute liver injury.Conclusions: In acute cocaine intoxication, higher ALT levels were associated with evidence of muscle damage, progression to acute renal failure, and death. Severe liver damage was observed in 5% of the sample and was associated with rhabdomyolysis and renal failure in all cases.