AMIODARONE HEPATOTOXICITY - PREVALENCE AND CLINICOPATHOLOGIC CORRELATIONS AMONG 104 PATIENTS
AMIODARONE HEPATOTOXICITY - PREVALENCE AND CLINICOPATHOLOGIC CORRELATIONS AMONG 104 PATIENTS
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DOI：
10.1002/hep.1840090504
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发表时间：
1989-05-01
期刊：
影响因子：
13.5
通讯作者：
ZIMMERMAN, HJ
中科院分区：
文献类型：
--
作者：
LEWIS, JH;RANARD, RC;ZIMMERMAN, HJ
对104例患者进行前瞻性随访，观察其明显胺碘酮相关肝损伤的发生率，并与文献报道进行比较。在大约四分之一的患者中检测到血清转氨酶水平无症状升高，这一数字与报告病例的平均值相似。肝外器官毒性的发生频率在水平升高的患者中增加。有症状的“肝炎”发生率为3%，文献中不到1%的病例。肝磷脂病的证据和假性酒精性肝损伤的发展最有可能分别是由于药物的生化作用和可能的代谢特异性。按照制造商的建议，连续的血酶测量可能会对更严重的肝损伤的发展提供一些保护。然而，停药后阿米达拉酮的水平可能在各种组织中持续数周至数月，停药并不能保证任何器官毒性的迅速逆转。因此，在停药前应仔细权衡阿米多拉烷带来的风险和益处，因为心脏性猝死的风险可能超过持续的肝、肺或其他毒性的危害。
The prevalence of apparent amiodarone-related hepatic injury in 104 patients followed prospectively is compared to that reported in the literature. Asymptomatic elevation of serum aminotransferase levels was detected in approximately one-fourth of the patients, a figure similar to the average of reported cases. The frequency of extrahepatic organ toxicity was increased in patients with elevated levels. Symptomatic "hepatitis" developed in 3% of this series and in less than 1% of cases in the literature. Evidence of hepatic phospholipidosis and the development of pseudoalcoholic liver injury is most likely due to the biochemical effect of the drug and to possible metabolic idiosyncrasy, respectively. Serial blood enzyme measurements, as recommended by the manufacture, may offer some protection against the development of more serious liver injury. However, levels of amidarone may persist in various tissue for weeks to months following withdrawal, and stopping the drug dose not guarantee the prompt reversal of any organ toxicity. Accordingly, the risks posed and benefits offered by amidorane should be carefully weighed prior to discontinuing the drug, as the risk of sudden cardiac death may outweigh the hazards of ongoing hepatic, pulmonary or other toxicity.