Sulphasalazine hepatotoxicity after 15 years' successful treatment for ulcerative colitis.
Sulphasalazine hepatotoxicity after 15 years' successful treatment for ulcerative colitis.
复制标题
柳氮磺吡啶成功治疗溃疡性结肠炎 15 年后出现肝毒性。
DOI：
10.1136/bmj.287.6385.96
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发表时间：
1983
影响因子：
--
通讯作者：
J. Farndon
中科院分区：
文献类型：
--
作者：
T. Lennard;J. Farndon
一名37岁男子在12岁时首次出现血性腹泻。溃疡性结肠炎诊断乙状结肠镜，放射学和组织学证据。他被开间歇性疗程的磺胺嘧啶治疗急性发作，效果良好，后来服用1克，每天4次，3年作为维持治疗。直到1979年11月，他的血清天冬氨酸转氨酶活性被发现为49 IU/l（正常范围0-37 IU/1），肝碱性磷酸酶活性为380 IU/l（正常范围30-130 IU/l），血清y-谷氨酰转移酶活性为49 IU/l（正常范围0-35 IU/1），才有肝功能障碍的证据。血清胆红素浓度正常，无黄疸。此时他服用磺胺嘧啶1-5克，每日4次，未服用其他药物。肝功能障碍归因于最近用氟烷麻醉，现已恢复正常。1982年3月，在每日4次服用磺胺嘧啶1克作为维持治疗时，肝功能出现异常。硫胶体肝扫描显示轻度增大的肝脏有中度斑片状摄取，肝活检未见明显异常。自身抗体和乙型肝炎抗原值正常。停用磺胺嘧啶治疗，肝功能检查恢复正常。结果他的结肠炎加重，并给予类固醇以控制病情。在知情同意的情况下进行药物挑战。每天4次磺胺嘧啶治疗24小时后，肝脏碱性磷酸酶活性升高至238 lU/1，血清天冬氨酸转氨酶活性升高至45 IU/ l，血清y-谷氨酰转移酶活性升高至296 IU/1
A 37 year old man had first presented at the age of 12 years with bloody diarrhoea. Ulcerative colitis was diagnosed on sigmoidoscopic, radiological, and histological evidence. He was prescribed intermittent courses of sulpha-salazine for acute exacerbations with good result and was later taking 1 g four times daily for three years as maintenance treatment. There was no evidence of liver dysfunction until November 1979 when his serum aspartate amino-transferase activity was found to be 49 IU/l (normal range 0-37 IU/1), hepatic alkaline phosphatase activity 380 IU/l (normal range 30-130 IU/l), and serum y-glutamyltransferase activity 49 IU/l (normal range 0-35 IU/1). His serum bilirubin concentration was normal and there was no jaundice. At this time he was taking sulphasalazine 1-5 g four times daily with no other drug. The liver dysfunction was ascribed to a recent anaesthetic with halothane and returned to normal. In March 1982 while he was taking sulphasalazine 1 g four times daily as maintenance treatment his liver function became abnormal. A sulphur colloid liver scan showed moderate and patchy uptake ina slightly enlarged liver, and liver biopsy indicated no notable abnormality. Values for autoantibodies and hepatitis B antigen were normal. Sulphasalazine treatmentwas stopped and the liver function tests returned to normal. Exacerbation of his colitis occurred as a result and steroids were given to gain control. A drug challenge was performed with informed consent. After treatment with sulphasalazine four times daily for 24 hours hepatic alkaline phosphatase activity rose to 238 lU/1, serum aspartate aminotransferase activity to 45 IU,/l, and serum y-glutamyltransferase activity to 296 IU/1, all from