在与代谢功能障碍相关的脂肪性肝病中,甲索酸诱导的肝毒性
Andrea Berkemeyer1, Ellen Wagner1, Shireen Hashmat2
1Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition Comer Children's Hospital, The University of Chicago Medicine Chicago Illinois USA.
JPGN reports
|November 29, 2024
概括
高剂量甲基酸盐 (HDMTX) 化疗可以导致致命的肝损伤,特别是在患有脂肪肝疾病的儿童中. 早期肝脏评估和考虑透析以延迟清除对于预防严重肝毒性至关重要.
科学领域:
- 儿科瘤学 儿科瘤学
- 肝病学 肝病学是一种肝病学.
- 毒理学 毒理学 毒理学
背景情况:
- 肝毒性是高剂量甲醇 (HDMTX) 化疗的严重不良影响.
- 这种风险在患有潜在的代谢功能障碍相关的脂肪性肝病 (MASLD) 或代谢相关的脂肪性肝炎 (MASH) 的儿科患者中增大.
- 未被诊断的肝病可以显著复杂化疗治疗.
研究的目的:
- 在接受HDMTX化疗的儿童中呈现严重肝毒性病例.
- 强调在高风险儿科群体中使用HDMTX前进行彻底肝脏评估的必要性.
- 突出透析在管理延迟甲醇清除和预防不可逆转的肝损伤方面的潜在作用.
主要方法:
- 一个12岁的男性患有B细胞急性淋巴细胞白血病的病例报告.
- 静脉注射高剂量甲状腺素 (HDMTX) 的使用.
- 监测不良事件,包括急性损伤和肝功能衰竭.
- 肝脏活检用于基因病理学确认甲状腺毒性.
主要成果:
- 患者在HDMTX24小时内发生急性损伤.
- 这种情况发展为急性肝衰竭,肝活检证实了甲醇毒性.
- 毒性被以前未被诊断的代谢功能障碍相关的脂肪性肝病所加剧.
- 患者的病情迅速恶化,阻止了肝移植,导致死亡.
结论:
- 在HDMTX化疗前,对于已知或疑似肝病的儿科患者,全面的肝脏评估至关重要.
- 与代谢功能障碍相关的脂肪性肝病显著增加了严重的HDMTX诱导肝毒性的风险.
- 对于延迟的甲状腺素清除,立即考虑透析对于减轻潜在的不可逆转的肝毒性至关重要.
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