Spectrum of statin hepatotoxicity: experience of the drug-induced liver injury network.
Spectrum of statin hepatotoxicity: experience of the drug-induced liver injury network.
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DOI：
10.1002/hep.27157
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发表时间：
2014-08
期刊：
影响因子：
13.5
通讯作者：
Bonkovsky, Herbert L.
中科院分区：
文献类型：
--
作者：
Russo, Mark W.;Hoofnagle, Jay H.;Gu, Jiezhun;Fontana, Robert J.;Barnhart, Huiman;Kleiner, David E.;Chalasani, Naga;Bonkovsky, Herbert L.
HMG-CoA还原酶抑制剂(他汀类)广泛用于高脂血症患者，耐受性良好。在接受治疗的患者中，高达3%的患者血清转氨酶轻度升高，但临床上明显的药物引起的肝损伤很少见。这项研究的目的是报告22例他汀类药物引起的临床明显肝损伤患者的临床特征和转归。在美国药物诱导肝损伤网络2004年至2012年登记的1188例药物诱导肝损伤病例中，有22例被归因于他汀类药物。所有患者都以标准的方式进行评估，并在发病后至少随访6个月。中位年龄60岁(41-80岁)，女性15例(68%)。发病潜伏期34天~10年(中位数155天)。峰值中值ALT 892U/L、碱性磷酸酶358U/L、总胆红素6.1 mg/dL。9例表现为淤胆型肝炎，12例表现为肝细胞损伤，其中6例为自身免疫表型。9名患者住院治疗，4名患者出现肝功能衰竭，1名患者死亡。所有常用的他汀类药物都有牵连。4名患者发展为慢性肝损伤，其中3名患者具有自身免疫性肝损伤表型。他汀类药物引起的肝损伤很少见，其特点是损伤类型多种多样，发病潜伏期不同，某些病例具有自身免疫特征，18%的患者具有自身免疫表型的持续性或慢性损伤。
The HMG-CoA reductase inhibitors (statins) are widely prescribed for patients with hyperlipidemia and are generally well tolerated. Mild elevations in serum aminotransferases arise in up to 3% of treated patients, but clinically apparent drug induced liver injury is rare. The aim of this study is to report the presenting features and outcomes of 22 patients with clinically apparent liver injury due to statins. Among 1188 cases of drug-induced liver injury enrolled between 2004 and 2012 in a prospective registry by the U.S. Drug Induced Liver Injury Network, 22 were attributed to a statin. All patients were evaluated in a standard fashion and followed for at least 6 months after onset. The median age was 60 years (range 41 – 80), and 15 (68%) were female. The latency to onset of liver injury ranged from 34 days to 10 years (median =155 days). Median peak levels were ALT 892 U/L, alkaline phosphatase 358 U/L and total bilirubin 6.1 mg/dL. Nine patients presented with cholestatic hepatitis and 12 patients presented with hepatocellular injury of which 6 had an autoimmune phenotype. Nine patients were hospitalized, 4 developed evidence of hepatic failure and 1 died. All commonly used statins were implicated. Four patients developed chronic liver injury of which three had an autoimmune phenotype of liver injury. Drug induced liver injury from statins is rare and characterized by variable patterns of injury, a range of latencies to onset, autoimmune features in some cases, and persistent or chronic injury in 18% of patients most of whom have an autoimmune phenotype.
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影响因子：
120.7
作者：
Schwartz, GG;Olsson, AG;Stern, T
通讯作者：
Stern, T
影响因子：
120.7
作者：
Serruys, PWJC;de Feyter, P;Meier, B
通讯作者：
Meier, B
影响因子：
4.2
作者：
Fontana RJ;Watkins PB;Bonkovsky HL;Chalasani N;Davern T;Serrano J;Rochon J;DILIN Study Group
通讯作者：
DILIN Study Group
影响因子：
13.5
作者：
Chalasani, N
通讯作者：
Chalasani, N
影响因子：
7.2
作者：
DANAN, G;BENICHOU, C
通讯作者：
BENICHOU, C