ASSOCIATION OF ACETAMINOPHEN HEPATOTOXICITY WITH FASTING AND ETHANOL USE
ASSOCIATION OF ACETAMINOPHEN HEPATOTOXICITY WITH FASTING AND ETHANOL USE
复制标题
DOI：
10.1001/jama.272.23.1845
复制
发表时间：
1994-12-21
影响因子：
120.7
通讯作者：
BLOCK, GD
中科院分区：
文献类型：
--
作者：
WHITCOMB, DC;BLOCK, GD
目的：评估禁食和酒精使用与因治疗原因而摄入对乙酰氨基酚引起的肝毒性的相关性。设计。-回顾性病例系列。设定。-匹兹堡大学(PA)医学中心的医院。患者。-使用一个全面的、全文索引的医学数据库，回顾从1987年1月到1993年7月的总共126779份出院摘要，以确定所有服用对乙酰氨基酚和肝脏毒性的患者。这些患者根据预期的醋氨酚使用和服用对乙酰氨基酚的剂量进行了分类。测量的主要结果。-确定了所有患者的长期饮酒、最近饮酒和最近禁食的独立变量。结果：确定了49名对乙酰氨基酚肝毒性患者(天冬氨酸转氨酶1000U/L)。21名患者(43%)出于治疗目的服用了对乙酰氨基酚。所有有肝毒性的患者服用的剂量都超过了推荐的4g/d。在每天服用4-10g扑热息痛后出现肝毒性的患者中，最近禁食比最近饮酒更常见(P=0.02)。最近饮酒量超过10g/d的人比服用4-10g/d的人更常见(P=0.004)。结论：对乙酰氨基酚在4-10g/d剂量后的肝毒性与禁食有关，与饮酒有关较少。服用扑热息痛治疗剂量大于10g/d后出现肝毒性的患者为酒精使用者。过量服用对乙酰氨基酚后，除了酒精摄入外，禁食似乎会增加肝脏毒性。
Objectives.-To evaluate the association of fasting and alcohol use with hepatotoxicity from acetaminophen ingested for therapeutic reasons.Design.-Retrospective case series.Setting.-Hospitals of the University of Pittsburgh (Pa) Medical Center.Patients.-A total of 126779 discharge summaries from January 1987 to July 1993 were reviewed using a comprehensive, whole-text-indexed medical database to identify all patients with acetaminophen ingestion and hepatotoxicity. These patients were categorized according to the intended acetaminophen use and dose of acetaminophen ingested.Main Outcomes Measured.-The independent variables of chronic alcohol use, recent alcohol use, and recent fasting were determined for all patients.Results.-Forty-nine patients with acetaminophen hepatotoxicity (aspartate aminotransferase > 1000 U/L) were identified. Twenty-one patients (43%) ingested acetaminophen for therapeutic purposes. All patients with hepatotoxicity took more than the recommended limit of 4 g/d. Recent fasting was more common than recent alcohol use among those who suffered hepatotoxicity after a dose of 4 to 10 g of acetaminophen per day (P=.02). Recent alcohol use was more common in the group who took more than 10 g/d than in those who took 4 to 10 g/d (P=.004).Conclusion.-Acetaminophen hepatotoxicity after a dose of 4 to 10 g/d was associated with fasting and less commonly with alcohol use. Patients who developed hepatoxicity after taking acetaminophen doses of greater than 10 g/d for therapeutic purposes were alcohol users. Acetaminophen hepatotoxicity after an overdose appears to be enhanced by fasting in addition to alcohol ingestion.