Are some people at increased risk of paracetamol-induced liver injury? A critical review of the literature.
Are some people at increased risk of paracetamol-induced liver injury? A critical review of the literature.
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DOI：
10.1007/s00228-017-2356-6
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发表时间：
2018-03
影响因子：
2.9
通讯作者：
Dear JW
中科院分区：
文献类型：
--
作者：
Caparrotta TM;Antoine DJ;Dear JW
扑热息痛是世界上最常用的药物之一。过量服用时，已明确具有肝毒性。本综述的目的是确定与人类暴露于扑热息痛后发生肝损伤相关的因素。 Google Scholar 和 PubMed 在 2016 年 12 月至 2017 年 3 月之间的不同日期进行了搜索。对确定的论文进行了参考文献分析，以进行可能相关的进一步研究。截至撰写本文时，几乎没有高质量的临床证据（来自对乙酰氨基酚过量或治疗用途的研究）表明任何人群都相对免受肝损伤或面临更大的肝损伤风险。在英国历史上用来表明较高风险的因素没有高质量的临床证据来支持它们重新引入临床实践。体重低于 50 公斤的患者服用扑热息痛的安全（且仍然有效）口服剂量尚未确定。没有任何患者群体明显面临扑热息痛引起的肝毒性风险升高。我们提出了两种值得进一步研究的临床方案。首先，需要确定低体重患者是否应该减少扑热息痛的剂量。其次，如果或当有关个体患者的基因组信息易于为处方提供信息时，我们建议应通过稳健设计的研究重新研究基因组对扑热息痛毒性的贡献。此类研究可以增强最常用药物之一的安全使用。本文的在线版本 (10.1007/s00228-017-2356-6) 包含补充材料，可供授权用户使用。
Paracetamol is one of the world’s most commonly used drugs. In overdose, it is well established to be hepatotoxic. The aim of this review was to identify factors that have been, or actually are, associated with the development of liver injury after paracetamol exposure in humans. Google Scholar and PubMed were searched on various dates between December 2016 and March 2017. Papers identified had their references analysed for further studies that might be relevant. At the time of writing, there was little good quality clinical evidence—from studies of paracetamol overdose or therapeutic use—to suggest that any groups of people are relatively protected from, or are at greater risk of, liver injury. The factors that were historically used to indicate higher risk in the UK have no good quality clinical evidence to support their re-introduction into clinical practice. The safe (and still effective) oral dose of paracetamol in patients weighing less than 50 kg has not been established. There is no patient group that is unequivocally at elevated risk of paracetamol-induced liver toxicity. We propose two clinical scenarios that warrant further research. Firstly, there is a need to establish whether the dose of paracetamol should be reduced in patients with low body weight. Secondly, if or when genomic information regarding individual patients becomes readily available to inform prescribing, we propose the contribution of the genome to paracetamol toxicity should be re-investigated with robustly designed studies. Such studies could enhance the safe use of one of the most frequently taken drugs. The online version of this article (10.1007/s00228-017-2356-6) contains supplementary material, which is available to authorized users.
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影响因子：
--
作者：
Claridge, Lee C.;Eksteen, Bertus;Holt, Andrew P.
通讯作者：
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DOI：
10.1124/jpet.112.202010
发表时间：
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影响因子：
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